ÎÎTreatment for neonatal candidiasis
>> AmB-d is recommended for neonates with disseminated
candidiasis. If no urinary tract involvement, LFAmB can be used.
Fluconazole is an alternative. Treat for 3 weeks. Echinocandins
used with caution, limited to when resistance or toxicity preclude
use of fluconazole or AmB-d. IV catheter removal recommended.
Nurseries with high rates of invasive candidiasis, consider
fluconazole prophylaxis in neonates < 1000 g.
ÎÎProphylaxis
>> Post-operative prophylaxis recommended in high risk liver,
pancreas, and small bowel transplant recipients, with fluconazole
or L-AmB for 7-14 days. Fluconazole recommended for high-risk
adult ICU patients if high incidence of invasive candidiasis. With
chemotherapy-induced neutropenia, caspofungin, fluconazole
or posaconazole recommended during induction chemotherapy
for duration of neutropenia. For stem cell transplant recipients
with neutropenia, fluconazole, micafungin or posaconazole,
recommended during the period of risk for neutropenia.
ÎÎDrug Monitoring
>> Therapeutic levels for itraconazole and voriconazole should be
obtained if the course for deep seated or refractory candidiasis
will be prolonged.
