The enigma of candiduria: evolution of bladder irrigation with amphotericin B for management--from Anecdote to Dogma and a lesson from Machiavelli.
Candiduria has emerged as a common, vexing diagnostic and therapeutic problem over the past 40 years. Treatment by means of bladder irrigation with a solution of amphotericin B has become widely used in clinical practice. However, the specifics of the procedure--concentration of amphotericin B, use of continuous washing vs. instillation with cross-clamping to allow "dwell-times," and duration of treatment--are based entirely on anecdotal experiences. The published reports and evolution of recommendations are reviewed. A prospective randomized double-blind study is needed to provide answers. In the meantime, administration of 200-300 mL of amphotericin B solution by triple-lumen urethral catheter with cross-clamping for 60-90 minutes seems most appropriate. Irrigation for no longer than 2 days should suffice if the procedure is to be effective. The optimal concentration of amphotericin B has not been defined; however, 5-10 mg/L appears adequate.
Sanford
J P
JP
Department of Medicine, University of Texas Southwestern Medical School, Dallas.
D000666:Amphotericin B / Q000008:administration & dosage*; D002177:Candidiasis / Q000188:drug therapy* / Q000382:microbiology / Q000652:urine; D006801:Humans; D007507:Therapeutic Irrigation; D001743:Urinary Bladder / Q000187:drug effects; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000382:microbiology; D014556:Urine / Q000382:microbiology*
D000666:Amphotericin B