Amphotericin B Bladder Instillation — Quick Guide for Clinicians
For fluconazole-resistant Candida cystitis • Intermittent (30-min) instillation • Use amphotericin B deoxycholate
Dose & Concentration

Standard Preparation

  • 50 mg amphotericin B deoxycholate in 1 L sterile water
  • Final conc: 50 mg/L (50 µg/mL)
  • Instill ≥30 mL per treatment by gravity
Once daily
~5 days
Reconstitution

Step-by-Step

  1. Reconstitute 50 mg lyophilized powder with 10 mL SWFI.
  2. Transfer and dilute to 1 L with sterile water.
  3. Label: “For Bladder Instillation Only”, 50 mg/L, storage, BUD.
Stability: Refrigerated 2–8 °C: up to 7 days • Room temp: up to 24 h.
Administration (30-min)

Intermittent Instillation

  1. Empty bladder via usual catheterization.
  2. Pour ≥30 mL into a clean specimen cup (not for storage).
  3. Attach catheter-tip syringe (plunger removed) to catheter.
  4. Gravity instill by holding syringe above bladder; do not force.
  5. Pinch catheter and remove gently to limit leakage.
  6. Dwell until next void or catheterization.
  7. Hand hygiene before/after.
Equipment

What You Need

  • Catheter, sterile field supplies
  • Catheter-tip syringe (primary delivery tool)
  • No special tubing; not a continuous irrigation
Formulation caution: Use amphotericin B deoxycholate. Formulations are not interchangeable.
Monitoring & Documentation
  • Assess for discomfort, bladder spasms, hematuria, or catheter trauma.
  • Maintain aseptic technique to avoid iatrogenic infection.
  • Record volume instilled, dwell, tolerance, and time of next void.
Adjust volume to patient comfort and bladder capacity; avoid over-distention.
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