FLUCONAZOLE THERAPY IN NEONATAL CANDIDEMIA

ABSTRACT

We reviewed 62 episodes (from 59 infants) of neonatal candidemia that occurred between January 1994 and June 1999. Except 5 term babies, all infants were premature (median gestational age [GA], 30 weeks) and birth weight was less than 2500 g (median, 1300 g). Most infants had reported risk factors and other neonatal problems. The age at onset of candidemia ranged from 15 to 173 days with a median of 34 days. In addition to catheter removal, all but one infants received antifungal agents and candidemia was eradicated subsequently in 46 episodes (75%). Eighteen infants with 19 episodes ever received fluconazole therapy. Fluconazole was administered as the first line agent in 6 episodes and successfully cleared candidemia in 5 episodes. Fluconazole was used as an alternative agent in an additional 13 episodes after amphotericin B (am B) ± flucytosine were given for a period without a satisfactory result and eradication of candidemia was achieved in 8 episodes subsequently. All 18 infants tolerated fluconazole well and no withdrawal was required on account of its adverse effect. In contrast, am B alone was administered as the first line agent in 55 episodes and successfully cleared candidemia in 32 episodes (58%). This retrospective analysis suggests that fluconazole appears to be safe in neonates and can be used as an alternative agent in treating neonatal candidemia. A large-scaled prospective study may be needed.

KEYWORD

Fluconazole - neonate - candidemia

REFERENCES

• 1 Baley J E. Neonatal candidiasis: the current challenge.  Clin Perinatol . 1991;  18 263-280
• 2 Butler K M, Baker C J. Candida: an increasingly important pathogen in the nursery.  Pediatr Clin North Am . 1988;  35 543-563
• 3 Ng P C. Systemic fungal infections in neonates.  Arch Dis Child . 1994;  71 F130-F135
• 4 Kossoff E H, Buescher E S, Karlowicz M G. Candidemia in a neonatal intensive care unit: trends during fifteen years and clinical features of 111 cases.  Pediatr Infect Dis J . 1998;  17 504-508
• 5 Butler K M, Rench M A, Baker C J. Amphotericin B as a single agent in the treatment of systemic candidiasis in neonates.  Pediatr Infect Dis J . 1990;  9 51-56
• 6 Baley J E, Meyers C, Kliegman R M, Jacobs M R, Blumer J L. Pharmacokinetics, outcome of treatment, and toxic effects of amphotericin B and 5-fluorocytosine in neonates.  J Pediatr . 1990;  116 791-797
• 7 Bodey G P. Azole antifungal agents.  Clin Infect Dis . 1992;  14(Suppl 1) S161-S169
• 8 Rex J, Pfaller M A, Barry A L. Randomized multicenter trial of fluconazole vs. amphotericin B as treatment of nonneutropenic patients with Candida fungemia.  N Engl J Med . 1994;  331 1325-1330
• 9 Fasano C, O'Keeffe J, Gibbs D. Fluconazole treatment of neonates and infants with severe fungal infections not treatable with conventional agents.  Eur J Clin Microbiol Infect Dis . 1994;  13 351-354
• 10 Driessen M, Ellis J B, Cooper P A. Fluconazole vs. amphotericin B for the treatment of neonatal fungal septicemia: a prospective randomized trial.  Pediatr Infect Dis J . 1996;  15 1107-1112
• 11 Wainer S, Coopet P A, Gouws H. A prospective study of fluconazole therapy in systemic neonatal fungal infection.  Pediatr Infect Dis J . 1997;  16 763-767
• 12 Huttova M, Hartmanova I, Kralinsky K. Candida fungemia in neonates treated with fluconazole: report of forty cases, including eight with meningitis.  Pediatr Infect Dis J . 1998;  17 1012-1015
• 13 Huang Y C, Lin T Y, Peng H L, Wu J H, Chang H Y, Leu H S. Outbreak of Candida albicans fungemia in a neonatal intensive care unit.  Scand J Infect Dis . 1998;  30 137-142
• 14 Huang Y C, Lin T Y, Leu H S, Peng H L, Wu J H, Chang H Y. Outbreak of Candida parapsilosis fungemia in neonatal intensive care units: clinical implications and genotyping analysis.  Infection . 1999;  27 97-102
• 15 Rowen J L, Tate J M, for the neonatal candidiasis study group. Management of neonatal candidiasis.  Pediatr Infect Dis J . 1998;  17 1007-1111
• 16 National Committee for Clinical Laboratory Standards. Reference method for broth dilution antifungal susceptibility testing of yeasts: approved standard NCCLS document M27-A. Pennsylvania: NCCLS; 1997