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Published on: February 14, 2018

Systemic antifungal drugs for invasive fungal infection in preterm infants

L Clerihew1, W McGuire

  • 1Tayside Institute of Child Health, Ninewells Hospital and Medical School, Dundee, UK, DD1 9SY.

The Cochrane Database of Systematic Reviews
|February 20, 2004
PubMed
Abstract

Insights

Limited data from one small trial show insufficient evidence to favor newer antifungal drugs over conventional amphotericin B for treating invasive fungal infections in preterm infants. Further research is needed.

Area of Science:

  • Neonatal Medicine
  • Infectious Diseases
  • Pharmacology

Background:

  • Invasive fungal infections (IFIs) pose a significant threat to preterm infants, contributing to mortality and morbidity.
  • While amphotericin B is a conventional treatment, newer antifungal agents and preparations are available.
  • There is a clinical need to evaluate the comparative effectiveness of these antifungal treatments.

Purpose of the Study:

  • To determine if newer systemic antifungal drugs or preparations reduce mortality and adverse neurodevelopmental outcomes in preterm infants with IFIs compared to conventional amphotericin B.
  • To synthesize evidence from randomized and quasi-randomized controlled trials.

Main Methods:

  • A systematic literature search was conducted using Cochrane Neonatal Review Group strategies, including CENTRAL, MEDLINE, and EMBASE.
  • Included were randomized and quasi-randomized trials comparing antifungal agents in preterm infants with suspected or confirmed IFIs.
  • Data extraction and quality assessment were performed independently, with outcomes including mortality, neurodevelopment, and adverse drug reactions.

Main Results:

  • Only one small trial was identified, comparing fluconazole with amphotericin B (with or without 5-Fluorocytosine).
  • Mortality rates were 3/11 with fluconazole and 4/10 with amphotericin B (Relative Risk: 0.68 [0.20, 2.33]).
  • No data on longer-term neurodevelopmental outcomes were available.

Conclusions:

  • Insufficient data exist from this single study to recommend newer antifungal agents over conventional amphotericin B for IFIs in preterm infants.
  • A large randomized controlled trial is necessary to compare newer antifungal preparations with conventional amphotericin B.
  • Further research should also investigate the convenience and cost-effectiveness of available antifungal drugs.

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