Question of the Week

For May 26, 2015

A 79-year-old man with advanced dementia is evaluated for an abnormal urinalysis. He has a chronic indwelling urinary catheter to help manage incontinence. He does not have diabetes mellitus or other immunocompromising conditions. He says he does not experience urinary urgency or other urinary symptoms. He is afebrile and has no suprapubic or costovertebral angle tenderness.

His urinalysis shows 1+ leukocyte esterase, negative nitrates, 5 white cells per high-power field (reference range, 0–2), and 3 red cells per high-power field (0–2). His urine culture grows 100,000 colony-forming units/mL of Candida albicans.

Which one of the following treatments is most appropriate for this patient?

Replacement of the urinary catheter
Bladder irrigation with amphotericin B
Intravenous fluconazole
Intravenous micafungin
Oral fluconazole