A Meta-analysis on the efficacy and safety of amphotericin B bladder irrigation in the treatment of urinary fungal infection

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.