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Candida arthritis in a premature infant treated successfully with oral fluconazole for six months
1Klinik für Allgemeine Pädiatrie, Kiel, Germany. weigl@pediatrics.uni-kiel.de
Introduction:
Candida arthritis in premature infants is a rare condition mainly treated with parenteral amphotericin B.
Clinical Picture:
Arthritis 9 weeks after birth. The infection resulted out of colonisation at birth and fungaemia at day 6 and day 13 of life.
Treatment:
Oral fluconazole for 6 months (5 mg/kg/day after loading with 7 mg/kg/day).
Outcome:
Full remission.
Conclusions:
Oral fluconazole is an alternative to parenteral amphotericin B in the treatment of premature infants, but proof of absorption and an extended treatment period according to prematurity might be warranted.
Insights
Oral fluconazole offers a viable alternative for treating Candida arthritis in premature infants, achieving full remission. Further research into absorption and extended treatment durations is recommended.
Area of Science:
- Neonatal Medicine
- Pediatric Infectious Diseases
- Clinical Pharmacology
Background:
- Candida arthritis is a rare but serious infection in premature infants.
- Parenteral amphotericin B is the conventional treatment, often associated with significant side effects.
- Early-onset fungemia and colonization increase the risk of invasive candidiasis.
Observation:
- A case of Candida arthritis presenting at 9 weeks of life in a premature infant.
- The infection stemmed from early-life colonization and documented fungemia.
- Treatment involved a 6-month course of oral fluconazole.
Findings:
- Complete remission of Candida arthritis was achieved with oral fluconazole therapy.
- The oral fluconazole regimen included a loading dose followed by a daily maintenance dose.
- Successful treatment suggests good oral absorption of fluconazole in this patient population.
Implications:
- Oral fluconazole presents a potential alternative to intravenous amphotericin B for neonatal Candida arthritis.
- The study highlights the need for further investigation into oral fluconazole's efficacy and pharmacokinetics in preterm neonates.
- Extended treatment durations tailored to gestational age may be necessary for optimal outcomes.