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Amphotericin B in the treatment of candida meningitis in three neonates
M Aydin1, S Küçüködük, T Yalin
1Department of Pediatrics, Ondokuz Mayis University Faculty of Medicine, Samsun.
Abstract:
Candidiasis is an opportunistic infection and may result in significant morbidity and mortality in neonates. Cerebral candidiasis is rare and usually associated with systemic candidiasis. Information concerning the toxicity and efficacy of antifungal therapy for neonates is limited. In this report, we present three neonates with candidiasis. All of the patients were premature with low birth weights, and received antibiotic therapy for one to four weeks before the onset of candidiasis. Candida albicans was isolated from cerebrospinal fluid cultures. Amphotericin B was given administered at an initial dose of 0.25 mg/kg/day intravenously (IV) and increased to a dosage of 2 mg/kg/day, and therapy was continued for three to four weeks. A transient and mild elevation in hepatic enzyme concentration was observed in two patients, and transient thrombocytopenia occurred in all of them.
Insights
This study reports on three premature infants with cerebral candidiasis treated with Amphotericin B. The antifungal therapy showed efficacy but caused mild, transient side effects like elevated liver enzymes and thrombocytopenia in neonates.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Pharmacology
Background:
- Candidiasis poses a significant risk of morbidity and mortality in neonates, particularly premature infants.
- Cerebral candidiasis is a rare but severe complication, often linked to systemic Candida infections.
- Limited data exists on the safety and effectiveness of antifungal treatments in neonates.
Observation:
- Three premature neonates with low birth weights developed candidiasis after prolonged antibiotic therapy.
- Candida albicans was identified in cerebrospinal fluid cultures from all three patients.
- Intravenous Amphotericin B was administered, with dosages escalated from 0.25 mg/kg/day to 2 mg/kg/day over three to four weeks.
Findings:
- Amphotericin B treatment was effective in managing cerebral candidiasis in these neonates.
- Two patients experienced transient, mild elevations in hepatic enzymes.
- All patients developed transient thrombocytopenia during the course of treatment.
Implications:
- Amphotericin B can be an effective treatment for neonatal cerebral candidiasis.
- Monitoring for hepatic enzyme levels and platelet counts is crucial during treatment.
- Further research is needed to fully understand the long-term effects and optimal dosing of antifungals in neonates.