A 28-week neonate develops clinical sepsis at day 10. Blood culture grows Candida parapsilosis. The correct initial antifungal agent and the most important concurrent non-pharmacological step is:
- A Amphotericin B deoxycholate; ophthalmologic examination
- B Fluconazole IV; remove all central venous catheters ✓
- C Micafungin IV; commence antifungal prophylaxis for 6 weeks
- D Voriconazole IV; lumbar puncture to exclude meningitis
Explanation
Candida parapsilosis is predominantly a catheter-associated organism. Fluconazole IV is appropriate for susceptible C. parapsilosis (which has lower intrinsic resistance to fluconazole compared to C. glabrata or C. krusei). The most critical concurrent step is prompt removal of central venous catheters, which dramatically reduces fungal burden and improves outcomes in neonatal candidiasis. Amphotericin B is used when azole resistance is suspected or for CNS disease. Ophthalmologic exam is important but is secondary to catheter removal. Micafungin is an alternative but not first-line for C. parapsilosis.
Reference: Ghai Essential Pediatrics, 10th ed.
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