69.承上題，鍾老太太應該接受下列何種處置？
(A)持續觀察
(B)fluconazole 200 mg PO qd for 14天
(C)amphotericin B 50 mg in 500 mL sterile water bladder irrigation bid
(D)caspofungin 50 mg IV qd

【APPLIED 有關無症狀菌尿】

Treatment of asymptomatic bacteriuria for prevention of subsequent infection and associated complications is routinely recommended in children and pregnant women.

◆ 小孩、孕婦常規治療以避免併發症

However, treatment of the elderly and patients with diabetes has not shown clear benefits and is not currently recommended.

◆ 老人、糖尿病沒有助益不建議治療

真菌感染沒症狀不特別吃

沒症狀也要吃: Ex: 孕婦尿中有細菌，預防UTI (用beta lactam，不用sulfa drug)

5F最佳解與這題無關吧 那個是細菌感染的情況 鍾老太太長的是candida

Candida infections of the bladder and kidneys

Asymptomatic candiduria — Asymptomatic candiduria rarely requires antifungal therapy unless it occurs in the setting of a condition that confers high risk of dissemination (neutropenia, very low birthweight infants (<1500 g), or urinary tract manipulation)

Antifungal therapy is not recommended unless the patient belongs to one of the groups listed above.

In contrast, patients who have a risk factor for disseminated infection should be treated as follows:

●Neutropenic patients and very low birthweight infants (<1500 g) with asymptomatic candiduria should be assumed to have disseminated infection and should be treated with an antifungal regimen recommended for candidemia. (See "Management of candidemia and invasive candidiasis in adults".)

●Patients with asymptomatic candiduria who will be undergoing a urologic procedure can be treated with oral fluconazole 400 mg (6 mg/kg) or amphotericin B deoxycholate 0.3 to 0.6 mg/kg intravenously (IV) daily for several days before and after the procedure.

Renal transplantation is no longer an absolute indication for treatment of asymptomatic candiduria, but therapy should be considered on a case-by-case basis [21]. Candiduria is most often treated in renal transplant recipients when there is a high risk for graft or device involvement, such as early after transplant when ureteral stents are in place.

Among asymptomatic patients without these risk factors, antifungal therapy has not been proven to be of value because rapid recurrence is common, selection of resistant Candida species is possible, and clinical outcomes do not appear to be improved

治療首選fluconazole，若resistant可使用amphotericin B IV

另外針對(C) irrigation，UpToDate認為Bladder irrigation with amphotericin B will clear funguria, but the effect is transient, and this treatment is not recommended for cystitis; it will clearly not be effective for pyelonephritis

不能使用liposomal amp B跟fungin類，因為尿道濃度低
(但還是有一些case reports使用fungin治療過UTI，畢竟選擇真的太少ˊ_>ˋ)