Treatment and prophylaxis of invasive candidiasis

Area of Science:

• Neonatology
• Infectious Diseases
• Pediatric Neurology

Background:

• Invasive candidiasis (IC) is a major cause of illness and death in preterm infants.
• IC can lead to lasting neurodevelopmental problems even after treatment.
• Preterm infants have a higher risk of Candida meningoencephalitis due to a more permeable blood-brain barrier.

Purpose of the Study:

• To review the treatment and prophylaxis strategies for invasive candidiasis in preterm infants.
• To emphasize the importance of antifungal agents with adequate central nervous system penetration.
• To discuss the potential role of targeted prophylaxis in managing IC in this population.

Main Methods:

• Literature review of antifungal treatments for invasive candidiasis.
• Analysis of current guidelines and research on antifungal prophylaxis in preterm neonates.
• Evaluation of drug penetration into the central nervous system for common antifungal agents.

Main Results:

• First-line treatments for IC include amphotericin B formulations, fluconazole, and micafungin.
• Fluconazole prophylaxis decreases IC incidence in extremely premature infants but lacks established safety and proven mortality reduction.
• The need for antifungals with sufficient CNS penetration is critical for treating or preventing Candida meningoencephalitis.

Conclusions:

• Effective management of invasive candidiasis in preterm infants requires careful selection of antifungals with adequate CNS penetration.
• While fluconazole prophylaxis shows promise in reducing IC incidence, its safety and impact on mortality require further investigation.
• Targeted prophylactic strategies may offer a future approach to mitigate the impact of invasive candidiasis in vulnerable preterm populations.