Intra-amniotic Fluconazole Therapy for Candida albicans Intra-amniotic Infection

• Published in: Obstetrics and gynecology (New York. 1953) Vol. 121; no. Suppl 2; pp. 452 - 454
• Main Authors: Bean, Lisa M., Jackson, Jessica R., Dobak, William J., Beiswenger, Timothy R., Thorp, James A.
• Format: Journal Article
• Language: English
• Published: United States The American College of Obstetricians and Gynecologists 01-02-2013
• Subjects: Abruptio Placentae - surgery; Adult; Amnion; Anti-Bacterial Agents - therapeutic use; Antifungal Agents - administration & dosage; Candidiasis - complications; Candidiasis - drug therapy; Cesarean Section; Chorioamnionitis - drug therapy; Chorioamnionitis - microbiology; Female; Fluconazole - administration & dosage; Humans; Infant, Newborn; Injections; Pregnancy; Pregnancy Complications, Infectious - drug therapy; Pregnancy Complications, Infectious - microbiology; Premature Birth - microbiology; Young Adult
• ISSN: 0029-7844; 1873-233X
• DOI: 10.1097/AOG.0b013e31827566ca

The consequences of intra-amniotic Candida infection can be devastating. Currently, standard management includes delivery. We identified only one previous case reporting intrauterine antifungal therapy, which used transcervical amphotericin B. We present two cases of intra-amniotic Candida infection treated with intra-amniotic fluconazole instilled before membrane rupture.
Two patients presented with intra-amniotic Candida albicans infection that was diagnosed during previability. Both underwent cerclage placement before culture results were available. Aggressive antifungal therapy was instituted using oral, vaginal, and intra-amniotic fluconazole instilled through serial amniocenteses. Both fetuses survived without sequelae.
Intra-amniotic Candida infection is associated with preterm rupture of membranes, preterm labor, severe neonatal infection, and fetal death. Early diagnosis and treatment is essential.