Neonatal fungemia and amphotericin B

Disseminated candidemia is a common nosocomial infection in the neonatal intensive care unit, though only a few studies have reported the outcome of amphotericin B therapy in neonatal candidiasis. Our treatment regimen consisted of an initial daily amphotericin B dose of 0.5 mg/kg. (For infants weighing > 1 kg, the second dose was increased to 1 mg/kg.) At 3 to 5 days, if the blood culture was negative, amphotericin B therapy was changed to every other day and continued for a total of 10 doses. Records of 36 patients given this regimen were reviewed for signs of toxicity or treatment failure. The mean birth weight was 988 +/- 510 g, and the gestational age was 28 +/- 3.9 weeks. The patients were ventilated for 13 +/- 15 days and had central lines for 6.7 +/- 9.3 days before development of candidemia. The mean age at onset of candidemia was 29.1 +/- 19.8 days. The interval from culture to treatment was 2.9 days. Six of 36 patients died, 2 of candidal meningitis and 4 of complications unrelated to candidal infection. Thirteen (36%) of the patients had candidal pustules during the course of their disease; 1 had osteomyelitis. There was no evidence of toxicity from this drug regimen and no apparent treatment failures. There were no changes in BUN and creatinine before or during therapy and no change in total urinary output. Blood cultures became sterile except in one patient who died on the first day of therapy. Most of the patients in this study had candidemia in the absence of a central indwelling catheter. Further prospective pharmacokinetic and therapeutic studies are warranted for this regimen of amphotericin B, which carries a low risk for toxicity.