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Candida

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5 Î A lumbar puncture and a dilated retinal examination are recommended in neonates with cultures positive for Candida species from blood and/or urine (S/L). Î CT or ultrasound imaging of the genitourinary tract, liver, and spleen should be performed if blood cultures are persistently positive for Candida spp. (S/L). Î Central venous catheter removal is strongly recommended (S/M). Î The recommended duration of therapy for candidemia without obvious metastatic complications is for 2 weeks after documented clearance of Candida species from the bloodstream and resolution of signs attributable to candidemia (S/L). CNS infections in Neonates Î For initial treatment, AmB deoxycholate, 1 mg/kg IV daily, is recommended (S/L). Î An alternative regimen is liposomal AmB, 5 mg/kg daily (S/L). Î The addition of flucytosine, 25 mg/kg 4 times daily, may be considered as salvage therapy in patients who have not had a clinical response to initial AmB therapy, but adverse effects are frequent (W/L). Î For step-down treatment after the patient has responded to initial treatment, fluconazole, 12 mg/kg daily, is recommended for isolates that are susceptible to fluconazole (S/L). Î Therapy should continue until all signs, symptoms, and CSF and radiological abnormalities, if present, have resolved (S/L). Î Infected CNS devices, including ventriculostomy drains and shunts, should be removed if at all possible (S/L). Prophylaxis in the Neonatal ICU Setting Î In nurseries with high rates (>10%) of invasive candidiasis, intravenous or oral fluconazole prophylaxis, 3-6 mg/kg twice weekly for 6 weeks, in neonates with birth weights <1000 g is recommended (S/H). Î Oral nystatin, 100,000 units 3 times daily for 6 weeks, is an alternative to fluconazole in neonates with birth weights <1500 g in situations in which availability or resistance preclude the use of fluconazole (W/M). Î Oral bovine lactoferrin (100 mg/day) may be effective in neonates <1500 g but is not currently available in U.S. hospitals (W/M).

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