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 2,500 g (median, 1,300 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.