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Boletín médico del Hospital Infantil de México

versión impresa ISSN 1665-1146


GRANADOS-PERALES, Diana E.  y  UGALDE-FERNANDEZ, J. Horacio. Successfully evolution of premature triplets with systemic neonatal candidiasis treated with caspofungin. Bol. Med. Hosp. Infant. Mex. [online]. 2010, vol.67, n.1, pp.52-57. ISSN 1665-1146.

Background: Infections caused by Candida sp. have been significantly increasing in patients in neonatal intensive care units (NICU) and are the most common causes of morbi-mortality in this population group. Amphotericin B has been considered to be the standard antifungal therapy. However, it has been associated with adverse effects such as persistent fungemia due to the increase of Candida resistance, in particular the non-albicans species, similar to the resistance shown by other antifungals such as fluconazol. Clinical cases: Triplets of gestational age of 29 weeks received advanced life support in the NICU, including mechanical ventilation (MV), insertion of venous catheters, total parenteral nutrition (TPN) and multiple regimes of broad-spectrum antibiotics. The three patients developed C. parapsilosis sepsis. Antifungal therapy was initiated with fluconazol prior to the use of conventional amphotericin B and liposomal amphotericin B. There was no clinical improvement and blood cultures remained positive. Clinical improvement was noted after the initiation of caspofungin (2 mg/kg/day) in addition to the use of liposomal amphotericin B. The triplets recovered completely with adequate tolerance to the medication and without adverse effects. Conclusion: Use of caspofungin proved to be an effective and well-tolerated therapy in these patients (2 mg/ kg/day). It can be considered an alternative treatment for invasive candidiasis in premature neonates, although optimal dosage remains undetermined.

Palabras llave : candidiasis; amphotericin B; prematurity; caspofungin.

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