Amphotericin B Treatment for Neonates with Invasive Candidiasis

Introduction to Amphotericin B Formulations

The American Academy of Pediatrics recommends amphotericin B deoxycholate at a dose of 1 mg/kg/day intravenously as a single daily dose for neonates with invasive candidiasis 1, 2
First-line therapy for invasive candidiasis in neonates is amphotericin B deoxycholate at 1-1.5 mg/kg/day intravenously as a single daily dose, as recommended by the Infectious Diseases Society of America 1, 3
Pharmacokinetics in neonates are relatively poorly defined, leading to some uncertainty regarding optimal dosage for hematogenous Candida meningoencephalitis (HCME), according to the Pediatric Infectious Diseases Society 1

Liposomal amphotericin B is recommended at 2.5-7 mg/kg/day intravenously as a single daily dose for neonates with invasive candidiasis, as suggested by the European Society of Clinical Microbiology and Infectious Diseases 1, 2
Amphotericin B lipid complex (ABLC) is an alternative option at 2.5-5 mg/kg/day intravenously as a single daily dose, graded as C-II (lower evidence) due to relative paucity of clinical data, according to the National Institutes of Health 1, 3
Preclinical data suggests effectiveness of ABLC for HCME, as reported by the American Society for Microbiology 6

Fluconazole may be used at 12 mg/kg/day with consideration of a 25 mg/kg loading dose for neonates with invasive candidiasis, as recommended by the Infectious Diseases Society of America 1, 3
Micafungin may be used at 4-10 mg/kg/day IV (higher doses for suspected HCME) for neonates with invasive candidiasis, as suggested by the Pediatric Infectious Diseases Society 1, 3
Caspofungin may be used at 25 mg/m²/day for neonates with invasive candidiasis, as recommended by the European Society of Clinical Microbiology and Infectious Diseases 1, 3

For HCME, longer treatment courses of amphotericin B may be necessary, as suggested by the American Academy of Pediatrics 1
Failure to consider CNS involvement (HCME) when treating neonatal candidiasis is a common pitfall, as reported by the American Society for Microbiology 6
Not adjusting dosing based on the specific amphotericin B formulation being used is a common caveat, as recommended by the Infectious Diseases Society of America 1, 3