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Antifungal prophylaxis for the prevention of neonatal candidiasis?

Michael J O'Grady1, Eugene M Dempsey

  • 1Department of Paediatrics and Newborn Medicine, Coombe Women's Hospital, Dublin, Republic of Ireland.

Acta Paediatrica (Oslo, Norway : 1992)
|March 28, 2008
PubMed

Insights

Antifungal prophylaxis is used by a majority of clinicians caring for very low birth weight (VLBW) neonates in the UK and Ireland. However, practices vary due to differing views on invasive fungal disease rates and lack of clear guidelines.

Area of Science:

  • Neonatal Medicine
  • Infectious Diseases
  • Pharmacology

Background:

  • Randomized trials indicate antifungal prophylaxis can reduce Candida infections in high-risk very low birth weight (VLBW) neonates.
  • The current use of antifungal prophylaxis in the UK and Ireland is not well-documented.

Purpose of the Study:

  • To determine the extent and patterns of antifungal prophylaxis use in VLBW neonates in the UK and Ireland.
  • To understand the rationale behind current practices in antifungal prophylaxis for VLBW infants.

Main Methods:

  • A postal questionnaire was sent to neonatologists in the UK and Ireland who care for VLBW infants.
  • Data collected included prophylactic agents, dosing, duration, and reasons for use or non-use.

Main Results:

  • The response rate was 55% (125/228).
  • 53% of respondents reported using antifungal prophylaxis, with oral nystatin and intravenous fluconazole being common first-line agents.
  • Common indications included antibiotic use (68%) and low birth weight (50%).

Conclusions:

  • A slight majority of clinicians routinely use antifungal prophylaxis for VLBW neonates.
  • Variations in practice may stem from differing perceptions of invasive fungal disease incidence, absence of established guidelines, and concerns about antifungal resistance.
Abstract

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