Fluconazole Prophylaxis in Neonates (Non-Systematic) Literature Review

Abdulaziz Almulhim

doi:10.4236/pp.2016.712053

Abstract

Background: Nosocomial infection remains an important contributing factor for morbidity and mortality in neonates. Coagulase-negative staphylococci have emerged as the predominant pathogens of late onset sepsis. This is followed by staphylococcus aurous, gram negative bacilli, and fungi. Old studies noted that mortality due to candidemia was higher in infants weigh less than 2000 g after being exposed to risk factors. The prophylactic use of fluconazole for the prevention of IC in extremely low birth weight was first reported in 2001. Methods: Current guidelines from Europe and North America that refer to the treatment of fungal infections are included. Literature search was performed using Medline, Scopus and Cochrane Central Register of Controlled Trials through March, 2016. Conclusion: Mortality was not different in early studies. However, recent studies concluded that mortality was reduced in the fluconazole arms. Risk-based approach towards fluconazole prophylaxis seems to be safe and effective.

Highlights

Nosocomial infection remains an important contributing factor for morbidity and mortality
The European Society of Medical Infectious Diseases recommends fluconazole as the drug of choice in extremely low birth weight infants in centers where the incidence of invasive candidiasis (IC) is more or equal to 2%, while centers were the incidence of IC is less than 2% should be made on a case-by-case basis and embedded in a risk stratifications strategy [7]
The incidence of candidiasis in their institution is low so they developed a risk based approach to initiate fluconazole in high risk neonates. They considered neonates with ELBW, gestational age of less than 28 weeks, and broad-spectrum antibiotics as major criteria and fluconazole will be discontinued once the risk factor is no longer available

Summary

Introduction

Nosocomial infection remains an important contributing factor for morbidity and mortality. Neonates in the NICU may be colonized with candida species after birth through two different mechanisms. Haematogenous Candida meningoencephalitis (HCME) is a unique syndrome in preterm infants, where candida invades the central nervous system This syndrome occurs in 15% - 20% of patients with invasive candidiasis and may contribute to long-term neurodevelopmental abnormalities [7]. The European Society of Medical Infectious Diseases recommends fluconazole as the drug of choice in extremely low birth weight infants in centers where the incidence of invasive candidiasis (IC) is more or equal to 2%, while centers were the incidence of IC is less than 2% should be made on a case-by-case basis and embedded in a risk stratifications strategy [7]. The prophylactic use of fluconazole for the prevention of IC in extremely low birth weight was first reported in 2001 [5]

Methods

Literature Review

Almulhim

Results