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Candida

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11 Î For C. krusei, AmB deoxycholate, 0.3-0.6 mg/kg daily, for 1-7 days is recommended (S/L). Î Elimination of urinary tract obstruction is strongly recommended (S/L). Î For patients who have nephrostomy tubes or stents in place, consider removal or replacement, if feasible (W/L). UTI Associated with Fungus Balls Î Surgical intervention is strongly recommended in adults (S/L). Î Antifungal treatment as noted above for cystitis or pyelonephritis is recommended (S/L). Î Irrigation through nephrostomy tubes, if present, with AmB deoxycholate, 25-50 mg in 200-500 mL sterile water, is recommended (S/L). XV. Vulvovaginal Candidiasis Î For the treatment of uncomplicated Candida vulvovaginitis, topical antifungal agents, with no one agent superior to another, are recommended (S/H). Î Alternatively, for the treatment of uncomplicated Candida vulvovaginitis, a single 150 mg oral dose of fluconazole is recommended (S/H). Î For severe acute Candida vulvovaginitis, fluconazole, 150 mg, given every 72 hours for a total of 2 or 3 doses, is recommended (S/H). Î For C. glabrata vulvovaginitis that is unresponsive to oral azoles, topical intravaginal boric acid, administered in a gelatin capsule, 600 mg daily, for 14 days is an alternative (S/L). Î Another alternative agent for C. glabrata infection is nystatin intravaginal suppositories, 100,000 units daily for 14 days (S/L). Î A third option for C. glabrata infection is topical 17% flucytosine cream alone or in combination with 3% AmB cream administered daily for 14 days (W/L). Î For recurring vulvovaginal candidiasis, 10-14 days of induction therapy with a topical agent or oral fluconazole, followed by fluconazole, 150 mg weekly for 6 months, is recommended (S/H).

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