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Neonatal candidaemia — RACP Paediatrics MCQ

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HardIDNeonatal candidaemiaRACP Paediatrics

A premature infant (25 weeks) on TPN via a central line develops persistent candidaemia (Candida albicans in blood cultures) despite 48 hours of IV fluconazole. Renal function is normal. What is the most appropriate change in antifungal therapy?

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Correct answer: A — IV amphotericin B

For persistent candidaemia not responding to fluconazole, amphotericin B (liposomal formulation preferred in neonates for reduced nephrotoxicity) is the escalation of choice. Central line removal is also essential for source control. Echinocandins (caspofungin, micafungin) are alternatives but have limited neonatal data.

Reference: Australian Therapeutic Guidelines – 2024 – Antibiotic; RCH Melbourne – 2023 – Neonatal Sepsis CPG