Selecting Drug Regimens for Urinary Tract Infections: Current Recommendations

Judith A. O'Donnell, MD, Steven P. Gelone, PharmD, Elias Abrutyn, MD; MCP Hahnemann University School of Medicine, Philadelphia Temple University Schools of Pharmacy and Medicine, Philadelphia.

Disclosures

Infect Med. 2002;19(1) 

In This Article

Fungal Infection

Many patients with a long-term indwelling catheter will have colonization of their bladder with Candida species or, rarely, other fungi. Except in special circumstances, funguria in the absence of pyuria should not be treated, and when possible, the catheter should be removed. Funguria with or without an indwelling catheter should be treated in renal transplant recipients and those undergoing an elective urologic procedure.[19] In these patient populations, treatment has been proved to be beneficial.[19]

A fungal UTI is identified by the presence of pyuria (more than 20 white blood cells per high-power field) and more than 105 fungal organisms per milliliter of urine. Patients with a fungal UTI may or may not have systemic findings, such as fever and leukocytosis. Whenever possible, the catheter should be removed, since this will result in cure in some patients. If antifungal therapy is initiated for Candida albicans infection, then oral fluconazole, 100 mg/d, should be prescribed for a 2- to 5-day course.[25] Because of its cost, intravenous fluconazole should be reserved for use only in those patients without the ability to take oral medications or in those with ileus or bowel obstruction.

Non-albicans Candida species, including Candida parapsilosis, Candida glabrata, and Candida krusei, are becoming more common in the hospital setting and often may be isolated in urine. When these yeasts are implicated in a catheter-associated UTI, the treatment should be either low-dose intravenous amphotericin B (0.1 mg/kg/d) or continuous amphotericin B bladder irrigation (5 to 50 mg/L of sterile water). Both regimens may be effective when given for 2 to 5 days.

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