Wednesday, April 26, 2006
Fungal, interstitial cystitis
Candiduria may respond to flucytosine 50 to 150 mg/kg/day po q 6 hr for 1 to 2 wk but often is resistant. Of the newer antifungal azole derivatives, fluconazole appears best for fungal UTI because of high oral bioavailability, once-per-day dosing, and excellent penetration into urine and CSF. Flucytosine or fluconazole 200 mg/day po should be prescribed for asymptomatic candiduria.
Symptomatic cystitis in the noncatheterized patient can be treated with flucytosine or fluconazole for 1 to 4 wk. Excellent results have also been obtained with a single dose of amphotericin B 0.3 mg/kg IV. In the presence of permanent indwelling catheters, flucytosine and fluconazole may reduce but rarely eradicate the funguria; bladder irrigation may be successful.
In patients with renal candidiasis, amphotericin B and high-dose fluconazole (>= 400 mg/day) are equally effective in the primary treatment of invasive infection with C. albicans and C. tropicalis. Even when amphotericin B is used initially, oral fluconazole should be substituted early in the course of treatment. However, some less common candidal species are not susceptible to fluconazole.
Interstitial Cystitis
Interstitial cystitis (IC) is a chronic bladder disease occurring primarily in women. Etiology is unknown. The bladder wall shows inflammatory infiltration with mucosal ulceration and scarring that results in smooth muscle contraction, diminished urinary capacity, hematuria, and frequent, painful urination. Carcinoma in situ can mimic IC and must be ruled out.
Bladder distension may provide excellent, but transient, relief. Intravesical agents (eg, dimethyl sulfoxide [DMSO], methylprednisolone, heparin sulfate) and oral therapy with anticholinergics or tricyclic antidepressants offer some relief. Rarely, augmentation cystoplasty may be undertaken. Very rarely, cystectomy with urinary diversion is required.
Symptomatic cystitis in the noncatheterized patient can be treated with flucytosine or fluconazole for 1 to 4 wk. Excellent results have also been obtained with a single dose of amphotericin B 0.3 mg/kg IV. In the presence of permanent indwelling catheters, flucytosine and fluconazole may reduce but rarely eradicate the funguria; bladder irrigation may be successful.
In patients with renal candidiasis, amphotericin B and high-dose fluconazole (>= 400 mg/day) are equally effective in the primary treatment of invasive infection with C. albicans and C. tropicalis. Even when amphotericin B is used initially, oral fluconazole should be substituted early in the course of treatment. However, some less common candidal species are not susceptible to fluconazole.
Interstitial Cystitis
Interstitial cystitis (IC) is a chronic bladder disease occurring primarily in women. Etiology is unknown. The bladder wall shows inflammatory infiltration with mucosal ulceration and scarring that results in smooth muscle contraction, diminished urinary capacity, hematuria, and frequent, painful urination. Carcinoma in situ can mimic IC and must be ruled out.
Bladder distension may provide excellent, but transient, relief. Intravesical agents (eg, dimethyl sulfoxide [DMSO], methylprednisolone, heparin sulfate) and oral therapy with anticholinergics or tricyclic antidepressants offer some relief. Rarely, augmentation cystoplasty may be undertaken. Very rarely, cystectomy with urinary diversion is required.
# posted by James @ 10:38 AM 
