Amphotericin B in the Management of Fungal Infections in a Neonatal Intensive Care Unit (NICU): Experiences in a Teaching Hospital

ABSTRACT

Background:Hospital-acquired pathogens cause considerable morbidity and mortality in preterm infants. Neonatal candidaemia plagued the neonatal ICU at Dr. George Mukhari Hospital. The standard treatment of candidaemia at the time of the study was fluconazole 10 mg/kg/day. The use of amphotericin B was introduced after identifying a problem with fluconazole resistance.Method:The application of the amphotericin B treatment protocol was monitored in the first 20 patients. A test dose of 0.25 mg/kg was administered with 0.25 mg/kg/dose increments until a maintenance dose of 1 mg/kg/dose was reached. Patients were kept on amphotericin B for one week after the first culture came back negative and were discharged as soon as the second blood culture also came back negative and they were clinically doing well. The patients' responses to amphotericin B were evaluated according to the laboratory data and clinical response.Results:Seventeen patients remained and were treated with amphotericin B for an average of 18.5 days (median=11 days) until the first negative Candida culture could be obtained; with a cumulative dose of 20.8 mg (median=19.2 mg) on average. The period to response in this study was relatively short.Conclusion:The specific strain cultured in this NICU could be eradicated with continuous use of amphotericin B. Further clinical investigation and improved infection control practices will be needed to decrease the incidence of invasive Candida infections; the duration of hospital stay associated with these infections and the side-effects associated with amphotericin B