Fluconazole therapy in neonatal candidemia

We reviewed 62 episodes (from 59 infants) of neonatal candidemia that occur red between January 1994 and June 1999. Except 5 term babies, all infants w ere premature (median gestational age [GA], 30 weeks) and birth weight was less than 2500 g (median, 1300 g). Most infants had reported risk factors a nd other neonatal problems. The age at onset of candidemia ranged from 15 t o 173 days with a median of 34 days. In addition to catheter removal, all b ut one infants received antifungal agents and candidemia was eradicated sub sequently in 46 episodes (75%). Eighteen infants with 19 episodes ever rece ived fluconazole therapy. Fluconazole was administered as the first line ag ent in 6 episodes and successfully cleared candidemia in 5 episodes. Flucon azole was used as an alternative agent in an additional 13 episodes after a mphotericin B (am B) +/- flucytosine were given for a period without a sati sfactory result and eradication of candidemia was achieved in 8 episodes su bsequently. All 18 infants tolerated fluconazole well and no withdrawal was required on account of its adverse effect. In contrast, am B alone was adm inistered as the first line agent in 55 episodes and successfully cleared c andidemia in 32 episodes (58%). This retrospective analysis suggests that f luconazole appears to be safe in neonates and can be used as an alternative agent in treating neonatal candidemia. A large-scaled prospective study ma y be needed.