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Fluconazole prophylaxis in preterm infants: a systematic review
Juliana Ferreira da Silva Rios1, Paulo Augusto Moreira Camargos2, Luísa Petri Corrêa1
1Universidade Federal de Minas Gerais, Santa Efigênia, BH, Brazil.
Insights
Antifungal prophylaxis with intravenous fluconazole significantly reduces Invasive Candidiasis and Candida colonization in premature newborns. This review highlights fluconazole
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Pharmacology
Background:
- Invasive Candidiasis is a serious threat to premature newborns.
- Antifungal prophylaxis is a potential strategy to reduce its incidence.
Purpose of the Study:
- To review the efficacy of intravenous fluconazole prophylaxis in preventing Invasive Candidiasis in premature infants.
- To assess the impact of fluconazole on Candida colonization and mortality.
Main Methods:
- Systematic review of studies from major databases (PubMed, Scopus, Cochrane, etc.).
- Keywords included: Antifungal, Candida, Fluconazole prophylaxis, Preterm infants.
- Evaluated outcomes: Invasive Candidiasis incidence, Candida colonization, mortality.
Main Results:
- Eleven of twelve studies showed a significant reduction in Invasive Candidiasis with fluconazole prophylaxis compared to placebo or no prophylaxis.
- Four of five studies reported a statistically significant lower proportion of Candida colonization in infants receiving fluconazole.
- One study indicated a significant reduction in mortality favoring fluconazole use.
Conclusions:
- Intravenous fluconazole prophylaxis is effective in reducing the incidence of Candida colonization and invasive fungal disease in premature newborns.
- The decision to use fluconazole should weigh benefits against risks, including incidence of candidiasis, mortality, drug safety, and potential for resistance.
Objective:
This article aims to review the use of antifungal prophylaxis with intravenous fluconazole in premature newborns and the occurrence of Invasive Candidiasis.
Methods:
This is a systematic review with search at databases: PubMed, Capes Portal, Virtual Health Library (BVS - Biblioteca Virtual em Saúde)/Lilacs, Scopus and Cochrane. The keywords used were: "Antifungal", "Candida" "Fluconazole prophylaxis" and "Preterm infants".
Results:
Invasive Candidiasis was evaluated in all the twelve items. In eleven of them, there was a statistically significant difference between the groups receiving prophylactic fluconazole, with lower frequency of Invasive Candidiasis, compared to placebo or no prophylaxis group. Colonization by Candida species was also evaluated in five studies; four of them presented statistically lower proportion of colonization in patients with Fluconazole prophylaxis, compared to placebo or no drugs. In one study, there was a significant difference, favoring the use of fluconazole, and reduction of death.
Conclusion:
Studies indicate the effectiveness of prophylaxis with fluconazole, with reduction in the incidence of colonization and invasive fungal disease. The benefits of prophylaxis should be evaluated considering the incidence of candidiasis in the unit, the mortality associated with candidiasis, the safety and toxicity of short and long-term medication, and the potential for development of resistant pathogens.
