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Fluconazole prophylaxis for prevention of invasive candidiasis in infants

Jessica E Ericson1, Daniel K Benjamin

  • 1aDuke Clinical Research Institute bDepartment of Pediatrics, Duke University, Durham, North Carolina, USA.

Current Opinion in Pediatrics
|March 15, 2014
PubMed

Insights

Fluconazole prophylaxis in premature infants is well-tolerated and reduces invasive candidiasis, especially when targeted to high-risk infants. This targeted approach minimizes treatment duration and patient exposure.

Area of Science:

  • Neonatal Medicine
  • Infectious Diseases
  • Pharmacology

Background:

  • Invasive candidiasis poses a significant threat to hospitalized infants, leading to high mortality and morbidity.
  • Fluconazole is FDA-approved for prophylaxis in bone marrow transplant patients but not for infants.
  • This review examines the historical use of fluconazole for prophylaxis in infants.

Purpose of the Study:

  • To review the history and efficacy of fluconazole prophylaxis in infants.
  • To evaluate the safety and impact of fluconazole prophylaxis in preventing invasive candidiasis in neonates.

Main Methods:

  • Literature review of studies on fluconazole prophylaxis in infants.
  • Analysis of data on fluconazole use, risk factors, and outcomes in neonatal intensive care units.

Main Results:

  • Targeting fluconazole prophylaxis to infants with risk factors (e.g., low birth weight, early gestational age) reduces the number of infants treated and treatment duration.
  • Fluconazole prophylaxis is well-tolerated in premature infants.
  • A reduction in invasive candidiasis incidence is observed, even with targeted prophylaxis.

Conclusions:

  • Fluconazole prophylaxis is safe and effective for premature infants, particularly those with multiple risk factors.
  • Centers with low invasive candidiasis rates may not benefit from universal prophylaxis.
  • No significant short-term or long-term toxicity or increased resistance has been observed in intensive care nurseries.
Abstract

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