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).