CoChat
Sign Up
Cited by 46Antifungal resistance and susceptibilityNeonatal and Maternal InfectionsFungal Infections and Studies

Antifungal agents in neonatal systemic candidiasis

Open access
van den Anker, J N, van Popele, N M, Sauer, P J·1995·Antimicrobial Agents and Chemotherapy
DOI 10.1128/aac.39.7.1391PMC PMC162751
Open this paper in CoChat — free account

Abstract

Neonatal systemic candidiasis is increasingly being recognized as a cause of septicemia in the neonatal intensive care unit (2, 19, 26, 36, 59). Predisposing factors for candidemia and subsequently invasive infections include prematurity, prolonged exposure to broad-spectrum antibiotics, the use of intravenous fat emulsions, the presence of necrotizing enterocolitis, prolonged intravascular catheterization, and tracheal intubation (33, 49, 50, 51, 63). Moreover, the immune functions of the newborn, especially in the preterm infant, are suboptimal, manifested as a decreased T-cell and granulocyte function (6, 22, 65). Additionally, it has been shown that lung macrophages of newborns have reduced anti-Candida activity (16). Infection is preceded generally by colonization of the gastrointestinal tract and the skin shortly after delivery (1, 27). Clinical evidence suggests that heavy colonization at multiple sites is a predisposing factor for clinical disease (27, 41), although this is still controversial (40). Most fungal infections in newborns are caused by Candida albicans, Candida parapsilosis, and more rarely, Candida tropicalis (1, 20, 42, 48). The symptoms of systemic candidal infection in the newborn are not specific. In several studies deterioration of respiratory function and apnea were the most common presenting signs, occurring in 70% of infants (2, 10, 26). Temperature instability, irritability, abdominal distension, carbohydrate intolerance, rash, and lethargy were also commonly observed. Similar symptoms are noted in newborns with bacterial infections, which occur frequently or coincidentally with systemic candidiasis. Therefore, most fungemic newborns are presumptively treated for bacterial infection. Since the signs, symptoms, and results of hematologic studies for infants suspected of having candidiasis are not specific, positive cultures are the mainstay in the diagnosis of invasive candidiasis. However, in newborn patients most antifungal therapy is started when fungal elements are seen on Gram stain or yeasts are isolated from some body fluid. On occasion it is even begun empirically or on the basis of the presence of a suggestive rash. Amphotericin B with or without flucytosine is still the treatment of choice for newborns with systemic candidiasis. However, since the introduction of ketoconazole in 1981, fluconazole in 1990, and intraconazole in 1992, these antifungal azoles, which unlike amphotericin B can be given orally, there has been a tendency to use these drugs as alternative therapies. Physicians have been influenced by the efficacy, safety, and ease of the administration of the azoles, despite the lack of direct comparisons of the efficacies of these drugs and amphotericin B. Our purpose here is to present an overview of the available pharmacokinetic data for amphotericin B, flucytosine, and this new group of azole drugs in the newborn. Dosage recommendations, recommendations for dosage adjustments in the face of organ system failure, and recommendations for monitoring toxicity will be suggested.

Integrity signals

Registry

Crossref · 10.1128/aac.39.7.1391

Cites

65 of 65 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

The text we found for this paper looks like another document, so its claims and self-check weren’t run. The registry and citation checks still apply.

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The text we found for this paper looks like another document, so the self-check wasn’t run.

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Related

Authors
van den Anker, J. N., van Popele, N. M., & Sauer, P. J.
Affiliations
  • Department of Pediatrics, Erasmus University, Rotterdam, The Netherlands.
  • Erasmus University Rotterdam (NL)
ORCID
Sauer, P J
Venue
Antimicrobial Agents and Chemotherapy
Publisher
American Society for Microbiology
Published
1995-07
Volume
39
Issue
7
Pages
1391-1397
ISSN
  • 0066-4804 (ISSN-L)
  • 1098-6596
DOI
10.1128/aac.39.7.1391
PMC
PMC162751
OpenAlex
W2073576384
Cited by
46
References
65
Citations by year
2023: 1 · 2017: 1 · 2015: 1 · 2014: 5 · 2013: 1
FWCI
2.80
Type
journal article
Language
en
Open access
Licence
journals.asm.org/non-commercial-tdm-license (tdm)
Locations
  • Antimicrobial Agents and Chemotherapy (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
  • RePub (Erasmus University Rotterdam) (submittedVersion)
Topics
  • Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Neonatal and Maternal Infections
  • Health Sciences › Medicine › Epidemiology › Fungal Infections and Studies
Keywords
antifungal agents, candidemia, Candida albicans, Candida parapsilosis, Candida tropicalis, amphotericin B, 5-fluorocytosine, ketoconazole, fluconazole, nystatin, caspofungin, echinocandins, antifungal prophylaxis, neonatal intensive care
MeSH terms
Antifungal Agents, Candidiasis, Humans, Infant, Newborn

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review