The treatment of systemic candidiasis in neonates with oral fluconazole

Fungal septicaemia has become a frequent problem in neonatal intensive care units. The usual treatment for this condition, amphotericin B alone or in combination with 5-fluorocytosine, is sometimes unsatisfactory, especially in neonates. We report our experience of fluconazole in neonates. Neonates who developed Candida septicaemia in the neonatal unit of Ga-Rankuwa Hospital (MEDUNSA) over a 1-year period were treated with oral fluconazole. The diagnosis was based on fungal cultures obtained from sites which are normally sterile. Blood cultures and renal, haematological and liver functions were monitored regularly. Therapy was continued for at least 1 week after the first negative culture was obtained. Twenty-one neonates were treated; the clinical and microbiological cure rate was 90.5%. No serious renal, haematological or hepatic complications were detected; mild hepatotoxicity was evidenced by elevated enzymes in a third of the children. Relapse occurred in one baby who received inadequate doses of fluconazole. Two babies died of causes unrelated to a systemic fungal infection. We conclude that fluconazole may be a safe and effective alternative for the management of systemic candidiasis in neonates. A comparative trial is necessary.