ORAL FLUCONAZOLE VERSUS AMPHOTERICIN-B BLADDER IRRIGATION FOR TREATMENT OF CANDIDAL FUNGURIA

A randomized trial was conducted to compare amphotericin B bladder irr igation (AmBBI) with oral fluconazole in terms of efficacy and safety in the treatment of candidal funguria. Fifty-three patients with two c onsecutive positive fungal cultures of urine were randomized to underg o AmBBI (50 mg/L over 24 hours or 50 mg/L for 7 days) or to receive fl uconazole (200 mg/d for 7 days). Urinary catheters were changed upon e ntry into the study and following therapy. Blood and urine specimens w ere obtained throughout the study. Candida albicans was the species is olated most frequently from urine cultures. Eradication rates for fung uria at 24 hours and 5-9 days after therapy were 82.4% and 75%, respec tively, with the 1-day AmBBI regimen; 94.4% and 78.6%, respectively, w ith the 7-day AmBBI regimen; and 83.3% and 76.9%, respectively, with f luconazole. There were no differences in the posttherapy eradication r ates between the regimens at 24 hours (P = .597) and at 5-9 days (P = .66). Candida glabrata was the predominant organism recovered from pat ients in the fluconazole group 5-9 days after the completion of therap y. Adverse events were limited to bladder fullness in a patient who un derwent AmBBI and hypoglycemia in a patient who received concomitant t herapy with fluconazole and glyburide. AmBBI (once or for 7 days) and fluconazole appear to be equally efficacious in the treatment of candi dal funguria.