Bladder irrigation with amphotericin B has been used to treat candidal cystitis but does not treat infections beyond the bladder and has a high relapse rate. May be useful for fluconazole resistant Candida species, e.g. Pichia kudriavzevii (previously C. krusei) or Nakaseomyces glabrata (previously C. glabrata).

Lipid formulations of amphotericin B should not be used due to low renal tissue concentrations.

Amphotericin B IV (see algorithm)

Test doses and incremental dosing are no longer recommended for the following reasons:

a. hypersensitivity reactions and anaphylaxis are rare

b. fever and chills associated with amphotericin B administration are not dose- or time-dependent

c. commercial formulation now in use is of high purity

d. causes unnecessary delays in patient receiving therapeutic dose.

The routine use of premedication (e.g. acetaminophen + diphenhydramine +/- corticosteroid +/- meperidine) is also no longer recommended prior to the initial dose of amphotericin B IV but may be administered promptly if an adverse reaction does occur, and then as pretreatment with subsequent amphotericin B doses.