JAC Advance Access published online on September 12, 2003
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkg419
© 2003 by The British Society for Antimicrobial Chemotherapy
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Original article
1 Department of Neonatology, Schneider Children's
Medical Center
of Israel, Petah Tikva, Israel; Sackler
Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
* Corresponding author. E-mail: linderm{at}netvision.net.il.
Received 6 April 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 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
Treatment of candidaemia in premature infants:
comparison of three amphotericin B preparations
2 Sackler
Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Infectious Disease Unit, Schneider Children's
Medical Center
of Israel, Petah Tikva, Israel
3 Pharmacy, Schneider Children's
Medical Center
of Israel, Petah Tikva, Israel
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.
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