Drug | Clinical uses | Dosing | Monitoring |
First-line agents | |||
Amphotericin B deoxycholate (conventional) |
| 1 mg/kg IV every 24 hours |
|
Fluconazole |
| For treatment: 25 mg/kg IV on day 1, followed by 12 mg/kg per dose IV once dailyΔ For prophylaxis: 6 mg/kg IV or orally twice weekly¶ |
|
Second-line agents | |||
Flucytosine |
| 25 mg/kg per dose orally every 6 hours |
|
Lipid complex or liposomal amphotericin B |
| 3 to 5 mg/kg per dose IV once daily |
|
Micafungin |
| 10 mg/kg per dose IV once daily |
|
Caspofungin |
| 25 mg/m2 per dose IV once daily |
|
AKI: acute kidney injury; ALT: alanine aminotransferase; AST: aspartate aminotransferase; CBC: complete blood count; CNS: central nervous system; Cr: creatinine; ELBW: extremely low birth weight; IV: intravenous; LFTs: liver function tests.
* Fluconazole should not be used as the agent for initial treatment of neonatal invasive candidiasis before the isolate's susceptibilities are known due to the potential for fluconazole-resistant Candida species. This is especially important if the neonate previously received fluconazole prophylaxis.
¶ Targeted antifungal prophylaxis is reserved for ELBW infants who are at highest risk of invasive Candida infection. This includes ELBW infants cared for in NICUs with a high baseline rate of systemic fungal infection (ie, >10%) and/or those who require antibiotic therapy for >48 hours (eg, for a confirmed bacterial infection or necrotizing enterocolitis).
Δ IV therapy is preferred over oral therapy for most invasive infections with the exception of simple cystitis, which can be treated with oral fluconazole if the neonate is clinically stable and tolerating feeds. Note that the dosing for fluconazole provided in the table above is for treatment of invasive candidiasis. Fluconazole may also be used to treat superficial mucocutaneous Candida infections (eg, oral thrush that does not respond to topical therapy). Lower dosing is used for treatment of oral thrush (3 to 6 mg/kg per dose given orally once daily for 7 to 14 days).آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟