• Treatment of systemic infections, meningitis, and severe superficial mycoses caused by
susceptible Candida spp. and Cryptococcus spp1
o If recent azole treatment, use alternative antifungal for systemic candidiasis if possible2
o For CNS infections1: may be used as step-down therapy for fluconazole-susceptible
isolates in neonates who respond to initial therapy of amphotericin B deoxycholate
• Invasive candidiasis and candidemia or VLBW with asymptomatic candiduria1,3
o If neonate has not been receiving prophylaxis with fluconazole, fluconazole IV or oral
is an alternative to amphotericin B deoxycholate
• In neonatal intensive care unit with greater than 10% rate3 of invasive candidiasis1,3
o If BW less than 1500 g and fluconazole unavailable, or fluconazole resistance present,
prophylaxis with oral nystatin (100 000 units 3 times daily oral for 6 weeks) is the
preferred alternative
• Coccidioidomycosis1

• Seek advice from paediatric ID specialist for complex cases
• For systemic candidiasis
o Commence IV and give loading dose
o Oral therapy only after stabilisation
• For severe infections or Candida strains with higher MIC (2–4 mg/L5,6)1, consider IV
loading dose
• If renal insufficiency (serum creatinine greater than 115 micromol/L)1, consider extended
dosing interval
• Duration
o Recommended duration for candidemia without obvious metastatic complications is for
two weeks after documented clearance of Candida spp. from the bloodstream and
resolution of signs attributable to candidaemia1,3
• If invasive candidiasis, removal of any CVL is strongly recommended3 (at SMO
discretion)
• Each 100 mL vial contains 15 mmol sodium; consider salt content of infusion fluid7
• Coccidioidomycosis
o Only endemic to the America’s but may be suspected if maternal travel there has
occurred
o If suspected, alert the laboratory to increase the likelihood of adherence to containment
precautions (inoculum needed for infection is small)
o Consult with paediatric ID specialist to guide dosage
Monitoring
• Liver function1,3 according to individual circumstances at SMO discretion
o Prophylaxis: consider baseline then fortnightly
o Treatment: consider baseline then minimum weekly
• If candidemia, blood cultures1 at SMO/paediatric ID discretion until clear
• Test for azole susceptibility for bloodstream and other clinically relevant Candida isolates
o Guides transition to azole therapy from amphotericin or echinocandins for neonates not
neutropenic, clinically stable and with repeat negative cultures on antifungal therapy
• If blood or urine cultures positive for Candida spp, lumbar puncture and ophthalmological
examination
• If blood cultures are persistently positive for Candida spp, ultrasound imaging (or CT if indicated) of the genitourinary tract, liver, and spleen
Compatibility
• Fluids
o 10% glucose1, 5% glucose4, 0.9% sodium chloride4
• Drugs:
o Do not mix with any drug prior to infusion (manufacturer recommendation).1
o Aciclovir4, amikacin4, amiodarone4, atracurium4, calcium chloride4, calcium folinate4,
cefalotin4, cefazolin4, cefoxitin4, dexamethasone4, dexmedetomidine4, dobutamine4,
dopamine4, droperidol4, erythromycin4, fentanyl4, filgrastim4, foscarnet4, ganciclovir4,
gentamicin4, glyceryl trinitrate4, granisetron4, heparin sodium4, hydrocortisone sodium
succinate4, lidocaine4, linezolid4, magnesium sulfate4, metoclopramide4,
metronidazole4, midazolam4, morphine sulfate4, noradrenaline (norepinephrine) 4,
piperacillin-tazobactam (EDTA-free)4, potassium chloride4, sodium bicarbonate4,
suxamethonium4, tobramycin4, vancomycin4, vecuronium4, verapamil4, zidovudine4
Incompatibility
• Fluids
o No information4
• Drugs
o Do not mix with any drug prior to infusion
o Ampicillin4, calcium gluconate4, ceftriaxone4, digoxin4, furosemide4, haloperidol lactate4