title: Treatment of candidaemia in premature infants: comparison of three amphotericin B preparations.
abstract: OBJECTIVE
  The objective of this study was to compare the effectiveness and tolerability of three antifungal preparations, amphotericin B, liposomal amphotericin B (LamB) and amphotericin B colloidal dispersion (ABCD), in the treatment of neonatal Candida bloodstream infection (CBSI).
  
  
  METHODS
  All patients hospitalized in the neonatal intensive care unit from 1996 to 2000 with CBSI were enrolled. Patients with a serum creatinine concentration of <1.2 mg/dL received amphotericin B, and those with serum creatinine > or =1.2 mg/dL received LamB or ABCD. Complete blood counts, and renal and hepatic function tests were obtained before, during and after treatment; blood cultures were performed daily until three consecutive cultures were negative. If cultures were positive for more than 10 days with clinical signs of fungal infection and/or persistent thrombocytopenia, a second antifungal drug was added.
  
  
  RESULTS
  Fifty-six infants met the study criteria: four term and 52 preterm, including 36 extremely low birth weight infants. Amphotericin B was the initial treatment for 34, LamB for 6 and ABCD for 16 infants. No differences in mortality were found between the three groups. Sterilization of the blood was achieved with amphotericin B in 67.6% of patients, LamB in 83.3% and ABCD in 57.1%, when used as monotherapy; with the addition of a second antifungal agent, success rates were 100%, 83.3% and 92.8%, respectively. There were no differences between the groups in the time to resolution of fungaemia. No patients had immediate local or systemic adverse events and none showed deterioration in renal function.
  
  
  CONCLUSIONS
  ABCD and LamB appear to be effective, safe and well tolerated in premature infants with CBSI and renal dysfunction. Larger trials are needed before routine use can be recommended.
authors.affiliation: Department of Neonatology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel. linderm@netvision.net.il
authors.forename: Nehama
authors.initials: N
authors.lastname: Linder
authors.forename: Gil
authors.initials: G
authors.lastname: Klinger
authors.forename: Itamar
authors.initials: I
authors.lastname: Shalit
authors.forename: Itzhak
authors.initials: I
authors.lastname: Levy
authors.forename: Shai
authors.initials: S
authors.lastname: Ashkenazi
authors.forename: Gali
authors.initials: G
authors.lastname: Haski
authors.forename: Orli
authors.initials: O
authors.lastname: Levit
authors.forename: Lea
authors.initials: L
authors.lastname: Sirota
mesh_terms: D000666:Amphotericin B / Q000008:administration & dosage*; D002177:Candidiasis / Q000188:drug therapy* / Q000378:metabolism; D002626:Chemistry, Pharmaceutical; D016009:Chi-Square Distribution; D003102:Colloids; D005260:Female; D016469:Fungemia / Q000188:drug therapy* / Q000378:metabolism; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000378:metabolism; D008081:Liposomes; D008297:Male
chemical_list: D003102:Colloids; D008081:Liposomes; D000666:Amphotericin B