An
antifungal agent (
Flucytosine) was used to treat urinary
candidiasis in 9 patients who had an
indwelling catheter and developed fungal colony counts greater than 10(4). Among 9 patients with
catheter drainage, urologic underlying diseases were
benign prostatic hyperplasia in 7 and a
neurogenic bladder in one patient all of whom had accompanied
diabetes mellitus. Only one patient was supravesically diverted from the upper urinary tract through an
indwelling catheter of bilateral ureterocutaneostomy after the removal of a tumorous bladder. All patients had previously received antimicrobials. Isolated strains of Candida were Candida albicans in 6, Candida tropicalis in 2, and Candida parapsilosis in one patient. Out of 9 patients having received daily administration of 1,500 mg
Flucytosine for 2 weeks, 7 patients subsequently had no yield of fungal colony after the treatment. Minimum inhibitory concentration (MIC) of this agent was determined at the range of 0.1 to 0.2 microgram/ml in 5 patients with C. albicans and 0.2 microgram/ml in both patients with C. tropicalis. Otherwise, a high MIC of over 100 micrograms/ml indicating resistance to this agent was observed in only 2 patients with C. albicans and C. parapsilosis. Three of the 7 patients had recurrent urinary
Candida infection even 2 weeks after the discontinuation of this antifungal
therapy despite rapid and excellent eradication of urinary
candidiasis. From these results,
Flucytosine may be one of the most promising
antifungal agent with a low MIC in the treatment of compromised urinary
Candida infection and should be occasionally supplemented with a topical instillation of
amphotericin B without any serious complication in the prevention of recurrence.