Fluconazole prophylaxis in preterm infants: a systematic review

Abstract

Studies indicate the effectiveness of prophylaxis with fluconazole, with reduction in the incidence of colonization and invasive fungal disease. The benefits of prophylaxis should be evaluated considering the incidence of candidiasis in the unit, the mortality associated with candidiasis, the safety and toxicity of short and long-term medication, and the potential for development of resistant pathogens.

Fluconazole Prophylaxis of Candida Infections in Preterm Neonates

“…Moreover, 73% of the surviving infants experienced either neurodevelopmental impairment post infection or died at long-term follow-up (12). The mortality rate usually reported is approximately 20% but it can reach up to 40% (13). Premature infants with invasive candidiasis are more likely to develop periventricular leukomalacia, retinopathy of prematurity, and chronic lung disease (6).…”

“…Since 2009 the fluconazole prophylaxis was recommended in NICUs with fungal infec tions rates higher than 5%. Later, the Infectious Diseases Society of America (IDSA) stated that prophylaxis for invasive candidiasis with fluconazole can be considered in VLBW newborns in NICUs with rates of candidiasis higher than 10%, based on placebo controlled randomized trials (13).…”

“…Rios et al published a review covering research at databases: PubMed, Capes Portal, Virtual Health Library Lilacs, Scopus, and Cochrane. Considering 168 articles the authors stated that there was a statistically significantly lower frequency of invasive candidiasis in the groups receiving prophylactic fluconazole compared to placebo or no prophylaxis groups in eleven of twelve items (13).…”

A Quality Improvement Project Aimed at Standardizing the Prescribing of Fluconazole Prophylaxis in a Level IV Neonatal Intensive Care Unit

“…Invasive fungal infections occur in 2% to 4% of very low birth weight infants (<1500 g) and 4% to 16% of extremely low birth weight infants (<1000 g). 1 This is due to a variety of factors including under-developed skin barriers, immunologic factors, abnormal microbial colonization of the gastrointestinal tract, and increased capability for gastrointestinal translocation. Additional factors further increase the risk of an invasive fungal infection, including central venous access, parenteral nutrition, broad spectrum antibiotics, and abdominal surgery, almost all of which a premature infant will encounter at some point during their neonatal intensive care unit (NICU) stay.…”

“…Invasive fungal infections occur in 2% to 4% of very low birth weight infants (<1500 g) and 4% to 16% of extremely low birth weight infants (<1000 g). 1 This is due to a variety of factors including under-developed skin barriers, immunologic factors, abnormal microbial colonization of the gastrointestinal tract, and increased capability for gastrointestinal translocation.…”