Amphotericin B as a Urologic Irrigant in the management of Noninvasive Candiduria

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Abstract
High urinary colony counts of Candida may develop in patients with prolonged indwelling bladder catheters, multiple antibiotic usage and compromised host resistance. Serum candidal antibody titers may differentiate candidal colonization or early infection from invasive or disseminated infection. The persistence of marked candiduria in the absence of elevated antibody titers or other manifestations of disseminated infection presents a therapeutic dilemma to the urologist. Should the patient be treated with systemic therapy, that is flucytosine or i.v. amphotericin B, or should he be observed until the signs of systemic or renal infection develop? Amphotericin B may be used as a urological irrigant in the management of noninvasive urinary fungal infection. Of 40 patients with persistent candiduria treated with daily irrigations of amphotericin B via a 3-way indwelling urethral catheter or urethral catheter and suprapubic tube for an average of 6 days, 37 (92.5%) demonstrated marked reduction or elimination of the candiduria. None of the patients had an adverse reaction. Amphotericin B also has been used as a urological adjuvant to surgical treatment of candidal infection of the kidney and upper tract. It also has a role in the treatment in candidal urethritis. Thus, the timely use of amphotericin B irrigations may prevent the development of disseminated candidal infection.