Experience with caspofungin in the treatment of persistent fungemia in neonates.
OBJECTIVE
To review our experience of caspofungin in the treatment of persistent candidemia in the neonatal intensive care unit.


METHODS
This was a retrospective chart review on 13 infants in whom caspofungin was added to conventional antifungals (amphotericin B and/or fluconazole or flucytosine) for the treatment of refractory candidemia.


RESULTS
A total of 12 infants were preterm (gestational age, 24 to 28 weeks) and one was term; the median birth weight was 800 g (range, 530 to 5600 g). Candidemia (Candida albicans in five, C. parapsilosis in six, C. albicans and C. parapsilosis in one and C. tropicalis in one) persisted despite 6 to 30 days of conventional antifungal therapy. After the addition of caspofungin, sterilization of blood cultures was achieved in 11 infants at the median time of 3 days (range, 1 to 21 days). Adverse events included thrombophlebitis (one patient), hypokalemia (two patients) and elevation of liver enzymes (four patients). Three infants had a second episode of candidemia and seven patients died.


CONCLUSIONS
Caspofungin may be an efficacious addition for treatment of candidemia refractory to conventional antifungal therapy. This drug should be further investigated in neonates.
Natarajan
Girija
G
Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI 48201, USA.
Lulic-Botica
Mirjana
M
Rongkavilit
Chokechai
C
Pappas
Athina
A
Bedard
Mary
M
D000666:Amphotericin B / Q000009:adverse effects / Q000627:therapeutic use; D000935:Antifungal Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002177:Candidiasis / Q000188:drug therapy*; D000077336:Caspofungin; D004359:Drug Therapy, Combination; D054714:Echinocandins; D005260:Female; D015725:Fluconazole / Q000009:adverse effects / Q000627:therapeutic use; D005437:Flucytosine / Q000009:adverse effects / Q000627:therapeutic use; D016469:Fungemia / Q000188:drug therapy*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000188:drug therapy*; D019102:Infant, Very Low Birth Weight; D015931:Intensive Care, Neonatal; D055666:Lipopeptides; D008297:Male; D010456:Peptides, Cyclic / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies
D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D010456:Peptides, Cyclic; D000666:Amphotericin B; D015725:Fluconazole; D005437:Flucytosine; D000077336:Caspofungin