Serum amphotericin B concentration in a very premature infant with disseminated candidiasis

A 1,040-g premature baby was diagnosed to have disseminated candidiasis and treated with amphotericin B (AMB) and 5-fluorocytosine. During the treatment, an unexpectedly large dose of AMB was infused unintentionally. AMB level was as high as 1.73 micrograms/mL soon after 5 mg/kg infusion instead of 0.5 mg/kg. However, it dropped rapidly to 0.83 micrograms/mL after 24 hours. AMB was detected in patient's serum at a higher level than minimal inhibitory concentration as long as one month after treatment was stopped. The patient showed liver dysfunction but no nephrotoxicity. The further studies are needed to establish safe and effective treatment regimen in premature infants with disseminated candidiasis.