CLEARANCE OF FUNGURIA WITH SHORT-COURSE ANTIFUNGAL REGIMENS - A PROSPECTIVE, RANDOMIZED, CONTROLLED-STUDY

The effects of short-course antifungal regimens on funguria were studi ed in 180 hospitalized adults who did not have ascending urinary or de ep fungal infections but did have >1,000 cfu of yeast/mL in two consec utive urine cultures. Before treatment, efforts were made to eliminate factors conducive to funguria. No additional interventions were imple mented in the management of the control group (group A), whereas five experimental groups received short-course therapy as follows: oral adm inistration of fluconazole (group B); single-dose intravenous administ ration of amphotericin B (group C); and intermittent bladder irrigatio n with amphotericin B at low, medium, and high concentrations (groups D, E, and F, respectively). Urine was cultured on days 1 and 7 after a ntifungal treatment. The rate of spontaneous clearance of funguria in the control group was 40.0%. Rates of clearance in experimental groups B through F were 58.6%, 55.2%, 82.1% (P <.01), 86.7% (P <.001), and 8 3.3% (P <.001), respectively, on day 1 and 77.3% (P < .01), 72.0% (P < .05), 42.9%, 68.4%, and 68.2% (P <.05), respectively, on day 7. The de crement in yeast count was 60.8% for the control group. Decrements for experimental groups B through F were 80.5%, 74.2%, 94.2% (P <.01), 86 .7% (P <.05), and 95.3% (P <.001), respectively, on day 1 and 85.5% (P <.05), 80.7%, 75.7%, 87.9% (P <.05), and 76.4%, respectively, on day 7. We conclude that (1) the systemic regimens tested result in prolong ed clearance of funguria and prompt decreases in yeast count and (2) l ocal irrigation with amphotericin B has prompt but short-lived effects regardless of the drug concentration used.