Prevention of Invasive Candidiasis in Premature Neonates: Administering Fluconazole or Not?

Abstract

Fluconazole prophylaxis (FP) for invasive candidiasis (IC) in preterm newborns is still a debated topic. In this review, we describe the most important papers on the topic, and we discuss pros and cons of the use FP in newborns according to these paper’s findings. Since 2001, several studies have been published on the use of FP to prevent IC. While most of them agree on the effectiveness of FP in reducing IC, especially in NICUs with high IC rates, the lack of evidence of decrease in overall mortality, and the risks associated with fluconazole administration both concerning neurodevelopmental impairment and the increase in Candida resistances still pose great concern against the universal implementation of FP. A local risk-based selection strategy could represent the best choice to optimize the benefits of FP and minimize the potential long-term toxicity and the development of resistant pathogens.