Recommendations
| Дозування | Ремарки | |
|---|---|---|
|
1st choice
|
fluconazole IV loading dose 800 mg, then 400 mg once daily
|
SWAB remarks Candida pyelonephritis / symptomatic candiduria. Duration up to 2 weeks after relief of obstruction. SWABID (National) remarks Oral treatment is possible: fluconazole loading dose 800 mg, then 400 mg once daily |
Symptomatic candiduria with fluconazole resistance: amphotericin B bladder irrigation.
Volume of bladder instillation: 100 mL, leave in for as long as possible — usually this is a maximum of 1–2 hours due to endogenous urine production. This should be once daily. The dose in international guidelines is 50 mg/L but this is not stable. 100 mg/L is stable. Because amphotericin B deoxycholate is not absorbed, this is not a problem.
Renal pelvis irrigations: 500–1000 mL per side over 12–24 hours. Usually 12 hours antifungal and 12 hours NaCl (500 mL + 500 mL); alternatively irrigate continuously for 24 hours with antifungal therapy because amphotericin B is incompatible with saline.
Asymptomatic candiduria: where possible remove the catheter, no antifungal therapy.
Treat as renal candidiasis only in low birth weight neonates, patients with renal transplantation, severe neutropenia or planned surgical procedures on the urinary tract.