NEODOSE

INDICATIONS

Treatment of systemic fungal infections resistant to conventional amphotericin B therapy or in patients with renal or hepatic dysfunction.

Neonatal Candidiasis, Including CNS Infection

• Invasive candidiasis and candidemia, or very low-birth weight infants with asymptomatic candiduria:
  • Amphotericin B deoxycholate is recommended.
  • Fluconazole IV or oral is an alternative for those who have not been receiving rophylaxis with fluconazole.
  • Lipid formulation amphotericin B agent is a alternative; however, use with caution, especially in the presence of urinar tract involvement.
  • Echinocandins (caspofungin, anidulafungin, o micafungin) should be limited to salvage therapy or scenarios of resistance or toxicity to amphotericin B deoxycholate or fluconazole
• Central nervous system infections:
  • Amphotericin B deoxycholate is recommended.
  • Liposomal amphotericin B agent is an alternative.
  • Salvage therapy with flucytosine may be added in those patients who have not responded to initial therapy.
  • Fluconazole may be used as step-down therapy for those patients who respond to initial therapy
• Neonatal intensive care unit (with greater than 10% rate of invasive candidiasis):
  • Prophylaxis with IV or oral fluconazole for 6 weeks is recommended for neonates with birth weights of less than 1000 g.
  • Prophylaxis with oral nystatin is an alternative in neonates with birth weights of less than 1500 g when fluconazole is unavailable or fluconazole resistance is present

Infective Endocarditis

• Infective Endocarditis:Infective endocarditis: The following recommendations are based on a consensus of experts. The full pediatric guidelines can be found here:

ADVERSE EFFECTS

Anemia, thrombocytopenia, hypokalemia, nausea/vomiting, and fever/chills.

ADMINISTRATION

Administer by IV infusion over 2 hours (2.5 mg/kg/hour) at a concentration of 1 to 2 mg/mL. If infusion lasts longer than 2 hours, shake the bag to mix the contents every 2 hours. Flush existing IV line with D5W prior to infusion or administer in a separate IV line. Do not infuse with saline solutions (precipitation will occur). Do not use an in-line filter to administer

MONITORING

For candidemia, monitor blood cultures daily or every other day until Candida is cleared