Clinical Use

  • Indication: Candida urinary tract infections (primarily cystitis) resistant to fluconazole.
  • Frequency & Duration: Once daily instillation for ~5 days (typical for cystitis), per clinical judgement and patient response.

Dose & Concentration

  • Standard prep for irrigation stock: 50 mg amphotericin B deoxycholate in 1 L sterile water → 50 mg/L (i.e., 50 µg/mL).
  • Per-instillation volume: ≥30 mL of the prepared 50 mg/L solution instilled by gravity (volume may be adjusted for comfort and bladder capacity; avoid over-distention).

Reconstitution & Preparation

  1. Reconstitute 50 mg lyophilized amphotericin B deoxycholate with 10 mL sterile water for injection (SWFI).
  2. Transfer and dilute to a final volume of 1 L with sterile water (for bladder irrigation).
  3. Label with concentration, beyond-use date/time, and storage conditions.
  4. Storage/Stability:
    • Refrigerated (2–8 °C): up to 7 days
    • Room temperature: up to 24 hours
  5. Do not use the specimen cup for storage; it is a pouring vessel only at time of administration.

Administration: 30-Minute Instillation (Intermittent)

  1. Empty bladder using usual catheterization technique.
  2. Aseptically pour ≥30 mL of the prepared solution into a clean specimen cup.
  3. Attach a catheter-tip syringe (plunger removed) to the catheter.
  4. Instill by gravity: hold syringe above bladder to allow gentle flow; do not force.
  5. When target volume has entered the bladder, pinch the catheter and remove gently to minimize leakage.
  6. Dwell: Medication remains in the bladder until next void or catheterization.
  7. Hand hygiene before and after the procedure.

Equipment/Tubing

  • Catheter-tip syringe (primary delivery tool).
  • No special irrigation tubing needed for this intermittent, gravity-assisted technique (this is not a continuous irrigation setup).

Practical Notes

  • The stock is prepared at 50 mg/L; each treatment uses a fraction (e.g., ≥30 mL) of that solution.
  • Adjust instilled volume based on patient comfort, bladder capacity, and clinical goals.
  • Use amphotericin B deoxycholate for this irrigation method (formulations are not interchangeable).
  • Ensure clear labeling to prevent IV administration errors—“For Bladder Instillation Only.”

Safety & Monitoring

  • Monitor for bladder discomfort, spasms, hematuria, or signs of catheter trauma.
  • Maintain aseptic technique to avoid introducing bacteria.
  • Review contraindications to catheterization and consider urology input if anatomic or procedural concerns exist.
  • Document volume instilled, dwell period, patient tolerance, and void timing.
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