Candida fungemia in neonates treated with fluconazole: report of forty cases, including eight with meningitis.

Abstract

PURPOSE OF THE STUDY:

To assess efficacy and safety of fluconazole in neonates with Candida fungemia.

STUDY DESIGN:

Multicenter prospective protocol of all fungemias appearing between January 1, 1993, and December 31, 1997, in four major university hospitals.

RESULTS:

Forty neonates, 28 of them with very low birth weight (<1500 g; 30.5 median gestation week), with documented Candida albicans fungemia were treated with intravenous fluconazole in a daily dosage of 6 mg/kg once daily for 6 to 48 days. Thirty-four received fluconazole as monotherapy and 6 received it in combination with amphotericin B. Thirty-two (80%) were cured; 4 of them relapsed despite at least 14 days of therapy, but they were ultimately cured without sequelae. Eight other neonates died, 4 because of fungal infection and 4 because of prematurity or hemorrhage or lung failure, with fungemia (20% overall and 10% attributable mortality). Two neonates had elevated liver enzymes during fluconazole therapy and 2 others had elevated serum creatinine during fluconazole monotherapy. In none of them did these abnormalities necessitate discontinuation of antifungal therapy. In 8 neonates fungal meningitis developed as a complication of fungemia. All but 3 fungemias were C. albicans; 3 were Candida parapsilosis.

CONCLUSIONS:

Fluconazole was safe and effective antifungal therapy even in complicated or Candida fungemia in neonates and in infants with very low birth weight.

• Authors: M Huttova, I Hartmanova, K Kralinsky, J Filka, J Uher, J Kurak, S Krizan, V Krcmery Jr
• Journal: The Pediatric infectious disease journal (Pediatr Infect Dis J) Vol. 17 Issue 11 Pg. 1012-5 (Nov 1998) ISSN: 0891-3668 [Print] United States
• PMID: 9849984 (Publication Type: Journal Article, Multicenter Study)

Chemical References

• Antifungal Agents
• Fluconazole

Topics

• Antifungal Agents (therapeutic use)
• Candidiasis (drug therapy)
• Female
• Fluconazole (therapeutic use)
• Fungemia (drug therapy)
• Humans
• Infant
• Infant, Newborn
• Male
• Meningitis, Fungal (drug therapy)
• Prospective Studies
• Treatment Outcome