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Efficacy and safety of fluconazole prophylaxis in extremely low birth weight infants: multicenter pre-post cohort

Juyoung Lee1, Han-Suk Kim2,3, Seung Han Shin4

  • 1Department of Pediatrics, Inha University School of Medicine, 100 Inharo, Incheon, Nam-gu, 22212, Korea.

BMC Pediatrics
|May 18, 2016
PubMed

Insights

Fluconazole prophylaxis did not reduce invasive fungal infections in extremely low birth weight infants. The study suggests targeted prophylaxis is needed due to potential resistance development.

Area of Science:

  • Neonatal Intensive Care
  • Infectious Diseases
  • Pharmacology

Background:

  • Invasive fungal infections (IFIs) are a concern in preterm infants.
  • Routine fluconazole prophylaxis in neonatal intensive care units (NICUs) may lead to antifungal resistance.
  • The efficacy and safety of fluconazole prophylaxis in extremely low birth weight (ELBW) infants require evaluation.

Purpose of the Study:

  • To evaluate the efficacy and safety of fluconazole prophylaxis in extremely low birth weight (ELBW) infants.
  • To assess the impact of fluconazole prophylaxis on invasive fungal infections (IFIs) and antifungal resistance in ELBW infants.

Main Methods:

  • An interventional pre-post cohort study comparing two 5-year periods with and without fluconazole prophylaxis in tertiary NICUs.
  • Data collected from Mar 2003-Feb 2008 (no prophylaxis) and Mar 2008-Feb 2013 (prophylaxis).
  • Prophylaxis involved administering fluconazole (3 mg/kg twice weekly for 4 weeks) starting on day 3 of life.

Main Results:

  • Fluconazole prophylaxis significantly lowered fungal colonization rates (59.1% vs. 33.9%).
  • However, the incidence of IFIs in ELBW infants was not reduced (4.4% vs. 5.5%).
  • A trend towards increased invasive infections by fluconazole-resistant Candida parapsilosis was observed (0% vs. 41.7%).

Conclusions:

  • Fluconazole prophylaxis was not effective in decreasing IFIs in ELBW infants.
  • Concerns exist regarding the emergence of antifungal resistance with routine prophylaxis.
  • Targeted prophylaxis strategies and further research on long-term resistance effects are necessary.
Abstract

Keywords:
FluconazoleInvasive candidiasisProphylaxisResistance

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