Oral itraconazole in treatment of candidemia in a pediatric intensive care unit.
OBJECTIVE
To examine efficacy of itraconazole in the treatment of candidemia in critically ill children.


METHODS
We studied retrospectively cases of candidemia seen consecutively in our Pediatric Intensive Care Unit (PICU) over three and half years. Candida isolates from those patients included. Candida albicans--19, C. tropicalis--31, C. guillermondii--9, C.krusei--4 and C. glabrata--1.


RESULTS
Of the 64 patients, 48 (75%) had symptoms suggestive of septicemia and 16 had no symptoms suggestive of septicemia. No antifungal therapy was given to asymptomatic patients; they recovered from candidemia without development of any sequelae. Of the 48 symptomatic patients 11 died before results of fungal culture became available and antifungal therapy could be started. Thirty seven patients were treated with itraconazole (10 mg/kg/day orally or through gastric tube). Seven (18.9 %) of 37 patients died, 3 within first week of antifungal therapy. Thirty (81%) patients recovered; microbiological cure was noted on average by day 14 (range 4-30 days). The mean +/- SD duration of therapy in patients who responded was 24 +/-7 days (range 21-42 days). None had any major side effect.


CONCLUSIONS
We conclude that oral itraconazole may be effective in treatment of candidemia in children in a PICU where non-C. albicans candida species constituted majority (70%) of all Candida isolates.
Singhi
Sunit C
SC
Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh 160-012, India. drsinghi@glide.net.in
Reddy
Thimmapuram C S
TC
Chakrabarti
Arunaloke
A
D000284:Administration, Oral; D000935:Antifungal Agents / Q000008:administration & dosage*; D002175:Candida / Q000302:isolation & purification; D002177:Candidiasis / Q000175:diagnosis / Q000188:drug therapy*; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D003428:Cross Infection / Q000175:diagnosis / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D016469:Fungemia / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D007194:India; D007223:Infant; D015278:Intensive Care Units, Pediatric; D017964:Itraconazole / Q000008:administration & dosage*; D008297:Male; D011336:Probability; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D000935:Antifungal Agents; D017964:Itraconazole