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).
