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Asymptomatic funguria

• Treatment indications: neutropenia, babies < 1.5kg, prior to GU tract procedures
• Preop treatment: fluconazole 6mg/kg/dose (max 400mg) PO daily or amphotericin B 0.3-0.6mg/kg/dose IV daily
• Tube exchange: no treatment required at time of foley, stent, or PCN

Fungal cystitis

• Treatment: fluconazole 3mg/kg/dose (max 200mg) PO daily x14d
• C glabrata treatment: amphoterocin B 0.3-0.6mg/kg/d IV daily x1-7d or flucytosine 25mg/kg/d PO QID x7-10d
• C krusei treatment: amphoterocin B 0.3-0.6mg/kg/d IV daily x1-7d
• Amphotericin bladder irrigation: for fluconazole-resistant infection and inability to receive systemic therapy, avoid if bladder perforation, no specified dosing, can cause dysuria/hematuria
• Fungus ball: requires systemic treatment and surgical removal

Upper tract fungal infection

• Pyelonephritis: remove obstruction if present, replace indwelling stent/PCN if present, treat similar to bladder infection dosing
• Fungus ball: requires systemic treatment and surgical removal, consider infusing amphotericin through nephrostomy tube (25-50mg in 200-500mL water)

Topical infections

• Candidal intertrigo: red pruritic skin with satellite lesions, treat with topical antifungal agent for 2+ weeks, may require oral agents, can use drying powders, consider workup for diabetes
• Dermatophyte infection (jock itch): caused by non-candidal fungal infection, sharply demarcated erythematous plaques with raised scaly border, keep areas dry, treat with topical antifungals (but do not treat postinflammatory hyperpigmentation seen in chronic infections)