Initial therapy for candidaemia in neonates
When treating candidaemia in neonates, an echinocandin is associated with fewer drug interactions and reduced toxicity compared to fluconazole. However, candidaemia originating from the central nervous system or urinary tract must be excluded before initiating therapy with an echinocandin. In neonates with meningitis or in whom meningitis has not been excluded, or those with candidaemia with a urinary tract source, fluconazole is a suitable alternative. If an echinocandin is used, micafungin is preferred because of increased experience with its use in neonates.
In neonates with candidaemia, if meningitis and a urinary tract source has been excluded, useKeighley, 2021:
1micafungin 10 mg/kg intravenously, daily; see advice on continuation therapy for candidaemia and duration of therapy for candidaemia micafungin
OR
2caspofungin 25 mg/m2 intravenously, daily1; see advice on continuation therapy for candidaemia and duration of therapy for candidaemia.Keighley, 2021 caspofungin
In neonates with confirmed or suspected meningitis or candidaemia originating in the urinary tract, use:
fluconazole 25 mg/kg intravenously, for the first dose, then 12 mg/kg intravenously, daily. See advice on continuation therapy for candidaemia and duration of therapy for candidaemia. fluconazole