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Article Navigation >  Journal of Pharmaceutical Practice and Service  > 2018  >  36(4): 379-384

BAI Xiangrong, CHENG Hongqin, ZHANG Yan, JIN Yin. A Meta-analysis on the efficacy and safety of amphotericin B bladder irrigation in the treatment of urinary fungal infection[J]. Journal of Pharmaceutical Practice and Service, 2018, 36(4): 379-384. doi: 10.3969/j.issn.1006-0111.2018.04.021
Citation: BAI Xiangrong, CHENG Hongqin, ZHANG Yan, JIN Yin. A Meta-analysis on the efficacy and safety of amphotericin B bladder irrigation in the treatment of urinary fungal infection[J]. Journal of Pharmaceutical Practice and Service, 2018, 36(4): 379-384. doi: 10.3969/j.issn.1006-0111.2018.04.021
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A Meta-analysis on the efficacy and safety of amphotericin B bladder irrigation in the treatment of urinary fungal infection

doi: 10.3969/j.issn.1006-0111.2018.04.021

  • Department of Pharmacy, Xuanwu Hospital, Capital Medical University, Beijing 10053, China

  • Received Date: 2017-07-03
  • Rev Recd Date: 2018-01-19
  • Objective Systematic evaluation of effectiveness and safety of amphotericin B bladder irrigation in urinary tract fungal infection. Methods Cross-sectional or controlled studies of amphotericin B bladder irrigation in the treatment of urinary tract fungal infection were collected by the search of Pubmed, Embase, WEB OF SCIENCE, Cochrane Library, Wanfang Database, ViP Database and SinoMed. Results 12 studies with 853 patients were included. Amphotericin B bladder irrigation had fungal clearance rate RR=0.81[0.75, 0.87] after 24 hours and 0.71[0.63, 0.79] after > 5 days. Clearance of candiduria in 24 hours with amphotericin B continuous irrigation was 0.83[0.75,0.91], while the intermittent bladder irrigation was 0.78[0.68,0.88]. Clearance of candiduria >5 days for those two groups was 0.74[0.65,0.84] and 0.60[0.44,0.76]. In the comparative studies with amphotericin B bladder irrigation vs fluconazole, clearance of candiduria in 24 hours and> 5 days was 1.27[1.07,1.50] and 0.92[0.78,1.10]. There was a report of hematuria with amphotericin B bladder irrigation. Conclusion Amphotericin B bladder irrigation showed similar efficacy in candiduria clearance as the systemic treatment with fluconazole. The continuous bladder irrigation with amphotericin B is more effective than intermittent irrigation. Due to the limited literatures available, the large scale double blinded clinical trials are needed to verify the efficacy.
  • [1] WISE GJ,WAINSTEIN S,GOLDBERG P,et al. Candidal cystitis. Management by continuous bladder irrigation with amphotericin B[J]. JAMA,1973,224(12):1636-1637.
    [2] WISE GJ,KOZINN PJ,GOLDBERG P. Amphotericin B as a urologic irrigant in the management of noninvasive candiduria[J]. J Urol,1982,128(1):82-84.
    [3] HSU CC,UKLEJA B. Clearance of Candida colonizing the urinary bladder by a two-day amphotericin B irrigation[J]. Infection,1990,18(5):280-282.
    [4] JACOBS LG,SKIDMORE EA,CARDOSO LA,et al. Bladder irrigation with amphotericin B for treatment of fungal urinary tract infections[J]. Clin Infect Dis,1994,18(3):313-318.
    [5] TRINH T,SIMONIAN J,VIGIL S,et al. Continuous versus intermittent bladder irrigation of amphotericin B for the treatment of candiduria[J]. J Urol,1995,154(6):2032-2034.
    [6] LEU HS,HUANG CT. Clearance of funguria with short-course antifungal regimens:a prospective,randomized,controlled study[J]. Clin Infect Dis,1995,20(5):1152-1157.
    [7] FAN-HAVARD P,O'DONOVAN C,SMITH SM,et al. Oral fluconazole versus amphotericin B bladder irrigation for treatment of candidal funguria[J]. Clin Infect Dis,1995,21(4):960-965.
    [8] FONG IW. The value of a single amphotericin B bladder washout in candiduria[J]. J Antimicrob Chemother,1995,36(6):1067-1071.
    [9] JACOBS LG,SKIDMORE EA,FREEMAN K,et al. Oral fluconazole compared with bladder irrigation with amphotericin B for treatment of fungal urinary tract infections in elderly patients[J]. Clin Infect Dis,1996,22(1):30-35.
    [10] NESBIT SA,KATZ LE,MCCLAIN BW,et al. Comparison of two concentrations of amphotericin B bladder irrigation in the treatment of funguria in patients with indwelling urinary catheters[J]. Am J Health Syst Pharm,1999,56(9):872-875.
    [11] 朱卫华,马峰. 两性霉素B膀胱冲洗治疗尿路真菌感染临床分析[J]. 中外医疗,2015,34(18):127-128,131.
    [12] SULLIVAN KA,CAYLOR MM,LIN FC,et al. Comparison of amphotericin B bladder irrigations versus fluconazole for the treatment of candiduria in intensive care unit patients[J]. J Pharm Pract,2017,30(3):347-352.
    [13] PAPPAS PG,KAUFFMAN CA,ANDES DR,et al. Clinical practice guideline for the management of candidiasis:2016 update by the Infectious Diseases Society of America[J]. Clin Infect Dis,2016,62(4):e1-50.
    [14] 李延鸿,朱怀军. 膀胱冲洗对预防留置导尿管引起尿路感染作用的系统评价[J]. 实用药物与临床,2012,15(8):494-496.
    [15] SOBEL JD,KAUFFMAN CA,MCKINSEY D,et al. Candiduria:a randomized,double-blind study of treatment with fluconazole and placebo. The National Institute of Allergy and Infectious Diseases (NIAID) Mycoses Study Group[J]. Clin Infect Dis,2000,30(1):19-24.
    [16] TUON FF,AMATO VS,PENTEADO FILHO SR. Bladder irrigation with amphotericin B and fungal urinary tract infection systematic review with Meta-analysis[J]. Int J Infect Dis,2009,13(6):701-706.
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A Meta-analysis on the efficacy and safety of amphotericin B bladder irrigation in the treatment of urinary fungal infection

doi: 10.3969/j.issn.1006-0111.2018.04.021
  • Department of Pharmacy, Xuanwu Hospital, Capital Medical University, Beijing 10053, China
  • Received Date: 2017-07-03
  • Rev Recd Date: 2018-01-19

Abstract: Objective Systematic evaluation of effectiveness and safety of amphotericin B bladder irrigation in urinary tract fungal infection. Methods Cross-sectional or controlled studies of amphotericin B bladder irrigation in the treatment of urinary tract fungal infection were collected by the search of Pubmed, Embase, WEB OF SCIENCE, Cochrane Library, Wanfang Database, ViP Database and SinoMed. Results 12 studies with 853 patients were included. Amphotericin B bladder irrigation had fungal clearance rate RR=0.81[0.75, 0.87] after 24 hours and 0.71[0.63, 0.79] after > 5 days. Clearance of candiduria in 24 hours with amphotericin B continuous irrigation was 0.83[0.75,0.91], while the intermittent bladder irrigation was 0.78[0.68,0.88]. Clearance of candiduria >5 days for those two groups was 0.74[0.65,0.84] and 0.60[0.44,0.76]. In the comparative studies with amphotericin B bladder irrigation vs fluconazole, clearance of candiduria in 24 hours and> 5 days was 1.27[1.07,1.50] and 0.92[0.78,1.10]. There was a report of hematuria with amphotericin B bladder irrigation. Conclusion Amphotericin B bladder irrigation showed similar efficacy in candiduria clearance as the systemic treatment with fluconazole. The continuous bladder irrigation with amphotericin B is more effective than intermittent irrigation. Due to the limited literatures available, the large scale double blinded clinical trials are needed to verify the efficacy.

BAI Xiangrong, CHENG Hongqin, ZHANG Yan, JIN Yin. A Meta-analysis on the efficacy and safety of amphotericin B bladder irrigation in the treatment of urinary fungal infection[J]. Journal of Pharmaceutical Practice and Service, 2018, 36(4): 379-384. doi: 10.3969/j.issn.1006-0111.2018.04.021
Citation: BAI Xiangrong, CHENG Hongqin, ZHANG Yan, JIN Yin. A Meta-analysis on the efficacy and safety of amphotericin B bladder irrigation in the treatment of urinary fungal infection[J]. Journal of Pharmaceutical Practice and Service, 2018, 36(4): 379-384. doi: 10.3969/j.issn.1006-0111.2018.04.021
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