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Antifungal therapy for newborn infants with invasive fungal infection

Linda Clerihew1, William McGuire

  • 1Department of Paediatrics, Tayside Children’s Hospital, Dundee, UK.

The Cochrane Database of Systematic Reviews
|June 15, 2012
PubMed
Abstract

Insights

Limited trials exist for antifungal treatments in neonates. More research is needed to determine the best antifungal drugs for treating invasive fungal infections in newborns.

Area of Science:

  • Neonatal Medicine
  • Infectious Diseases
  • Pharmacology

Background:

  • Invasive fungal infections pose a significant threat to newborn infants.
  • Various antifungal agents, preparations, and combinations are available for treatment.
  • There is a critical need to evaluate the comparative effectiveness of these antifungal therapies.

Purpose of the Study:

  • To systematically review and assess the impact of different antifungal treatments on mortality and morbidity in neonates with invasive fungal infections.
  • To compare the efficacy of various antifungal drugs, drug preparations, and combinations in the neonatal population.

Main Methods:

  • Conducted a systematic literature search using the Cochrane Neonatal Review Group's strategy, including multiple databases and trial registries.
  • Included randomized and quasi-randomized controlled trials comparing antifungal agents or combinations in newborn infants.
  • Extracted data using standardized methods, evaluated trial quality, and synthesized findings using risk ratios and risk differences.

Main Results:

  • Only one small trial involving 24 neonates was identified.
  • The trial compared fluconazole with amphotericin B (with or without 5-fluorocytosine for meningitis).
  • No statistically significant difference in mortality was observed between the treatment groups (risk ratio 0.73; 95% CI 0.26 to 2.05).

Conclusions:

  • Current evidence is insufficient to guide clinical practice for antifungal treatment in neonates.
  • Large-scale, randomized controlled trials are essential to compare the efficacy and safety of different antifungal therapies.
  • Further research is required to establish optimal treatment strategies for invasive fungal infections in this vulnerable population.

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