JAC Advance Access originally published online on September 12, 2003
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Journal of Antimicrobial Chemotherapy (2003) 52, 663-667
© 2003 The British Society for Antimicrobial Chemotherapy
Treatment of candidaemia in premature infants: comparison of three amphotericin B preparations
1 Department of Neonatology, 3 Infectious Disease Unit and 4 Pharmacy, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel; 2 Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Received 6 April 2003; returned 29 June 2003; revised 14 July 2003;; accepted 16 July 2003
Objective: The objective of this study was to compare the effectiveness and tolerability of three antifungal preparations, amphotericin B, liposomal amphotericin B (LamB) and amphotericin B colloidal dispersion (ABCD), in the treatment of neonatal Candida bloodstream infection (CBSI).
Patients and methods: All patients hospitalized in the neonatal intensive care unit from 1996 to 2000 with CBSI were enrolled. Patients with a serum creatinine concentration of <1.2 mg/dL received amphotericin B, and those with serum creatinine 
1.2 mg/dL received LamB or ABCD. Complete blood counts, and renal and hepatic function tests were obtained before, during and after treatment; blood cultures were performed daily until three consecutive cultures were negative. If cultures were positive for more than 10 days with clinical signs of fungal infection and/or persistent thrombocytopenia, a second antifungal drug was added.
Results: Fifty-six infants met the study criteria: four term and 52 preterm, including 36 extremely low birth weight infants. Amphotericin B was the initial treatment for 34, LamB for 6 and ABCD for 16 infants. No differences in mortality were found between the three groups. Sterilization of the blood was achieved with amphotericin B in 67.6% of patients, LamB in 83.3% and ABCD in 57.1%, when used as monotherapy; with the addition of a second antifungal agent, success rates were 100%, 83.3% and 92.8%, respectively. There were no differences between the groups in the time to resolution of fungaemia. No patients had immediate local or systemic adverse events and none showed deterioration in renal function.
Conclusion: ABCD and LamB appear to be effective, safe and well tolerated in premature infants with CBSI and renal dysfunction. Larger trials are needed before routine use can be recommended.
Keywords: liposomal amphotericin B, amphotericin B colloidal dispersion, Candida, premature infants
* Corresponding author. Tel: +972-3-9253753; Fax: +972-2-5340934; E-mail: linderm{at}netvision.net.il
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