Prophylactic systemic antifungal agents to prevent mortality and morbidity in very low birth weight infants

Abstract

Prophylactic systemic antifungal therapy reduces the incidence of invasive fungal infection in very low birth weight infants. This finding should be interpreted cautiously. The incidence of invasive fungal infection was very high in the control groups of some of the included trials. Furthermore, the trials may have been affected by ascertainment bias since use of prophylactic fluconazole may reduce the sensitivity of microbiological culture for detecting fungi in blood, urine, or cerebrospinal fluid. Meta-analysis does not demonstrate a statistically significant effect on overall mortality rates, but the 95% confidence interval around this estimate of effect is wide. There are currently only limited data on the long-term neurodevelopmental consequences for infants exposed to this intervention. In addition, there is a need for further data on the effect of the intervention on the emergence of organisms with antifungal resistance.

Prevention of invasiveCandidainfections in preterm infants: the time is now

“…From the aforementioned data, there is overwhelming evidence in support of fluconazole prophylaxis and the data are consistent with the recent Cochrane review [46]. The Cochrane review data revealed a statistically significant reduction in invasive fungal infections in infants who received prophylaxis (typical relative risk: 0.23; 95% CI: 0.11-0.46), with a number needed to treat of nine (95% CI: 6-17) [46].…”

Triazole Use in the Nursery: Fluconazole, Voriconazole, Posaconazole, and Ravuconazole

“…To date there have been five randomized controlled trials (RCTs) [52,[65][66][67][68], eight retrospective reviews [19,20,[73][74][75][76][77][78], and a Cochrane review [79] examining fluconazole prophylaxis in neonates.…”

Impact of ‘targeted’ fluconazole prophylaxis for preterm neonates: efficacy of a highly selective approach?

“…A reduction in invasive candidiasis with FP has been previously demonstrated in multiple randomized controlled trials and retrospective cohort studies. [5][6][7][8]13 Limited studies using a more targeted approach of prophylaxis to select high risk groups have reported success. Uko et al 14 reported the efficacy of targeted short-term prophylaxis during discrete periods of antibiotic administration in reducing invasive fungal infection, in comparison with a historic control who did not receive any prophylaxis.…”

“…3 Several studies have demonstrated that prophylactic fluconazole decreases fungal colonization and subsequent invasive fungal infection in PT infants. [4][5][6][7][8] The duration of prophylaxis in most of these studies is from 4 to 6 weeks, starting at birth to 3 days of age. 4,5,8 The risk of invasive candidiasis persists from birth to 3 months, with the highest risk reported to be between 11 and 20 days of life.…”

“…[4][5][6][7][8] The duration of prophylaxis in most of these studies is from 4 to 6 weeks, starting at birth to 3 days of age. 4,5,8 The risk of invasive candidiasis persists from birth to 3 months, with the highest risk reported to be between 11 and 20 days of life. 1 The approach of prophylaxis, from 4 to 6 weeks, to all extremely low birth weight infants treats a large number of infants for a prolonged duration, some of whom may be at low risk for infection.…”