Abstract
OBJECTIVE:
To review our experience of caspofungin in the treatment of persistent candidemia in the neonatal intensive care unit.
STUDY DESIGN:
This was a retrospective chart review on 13 infants in whom caspofungin was added to conventional antifungals (amphotericin B and/or fluconazole or flucytosine) for the treatment of refractory candidemia.
RESULTS:
A total of 12 infants were preterm (gestational age, 24 to 28 weeks) and one was term; the median birth weight was 800 g (range, 530 to 5600 g). Candidemia (Candida albicans in five, C. parapsilosis in six, C. albicans and C. parapsilosis in one and C. tropicalis in one) persisted despite 6 to 30 days of conventional antifungal therapy. After the addition of caspofungin, sterilization of blood cultures was achieved in 11 infants at the median time of 3 days (range, 1 to 21 days). Adverse events included thrombophlebitis (one patient), hypokalemia (two patients) and elevation of liver enzymes (four patients). Three infants had a second episode of candidemia and seven patients died.
CONCLUSION:
Caspofungin may be an efficacious addition for treatment of candidemia refractory to conventional antifungal therapy. This drug should be further investigated in neonates.
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Natarajan, G., Lulic-Botica, M., Rongkavilit, C. et al. Experience with Caspofungin in the Treatment of Persistent Fungemia in Neonates. J Perinatol 25, 770–777 (2005). https://doi.org/10.1038/sj.jp.7211380
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DOI: https://doi.org/10.1038/sj.jp.7211380
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