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Prophylactic Fluconazole Helps Protect Premature Infants
Prophylactic use of fluconazole appears highly effective in preventing fungal colonization and infection in preterm neonates, Italian researchers report in the January issue of Pediatrics.
In fact, lead investigator Dr. Paolo Manzoni told Reuters Health that "appropriate administration of prophylactic fluconazole in the neonatal intensive care settings could let some premature infants destined to death survive."
Dr. Manzoni and colleagues at Azienda Ospedaliera Regina Margherita-S. Anna, Turin note that systemic fungal infections are common in this population, but the benefit of prophylaxis is unclear.
To investigate further, the researchers conducted a retrospective study involving 465 neonates who weighed less than 1500 g and were treated in their neonatal intensive care unit. They were admitted between 1998 and 2000 when prophylactic fluconazole was not used and between 2001 and 2003 when such prophylaxis became standard.
Neonates weighing less than 1000 g at birth were treated for 45 days with fluconazole. Those weighing more had 30 days of therapy.
Overall, fungal colonization was significantly lower in the fluconazole group (24.0%) than it was in those who did not receive the agent (43.8%). This was also true of colonization in multiple sites (2.6% versus 5.8%), colonization from high-risk sites (5.8% versus 19.2%) and systemic fungal infection (4.4% versus 16.7%). Benefits were particularly marked in infants below 1000 g.
Crude mortality from Candida species was zero in the prophylaxis group and 1.7% in the other group. Although overall mortality was similar in both groups, mortality in colonized infants was significantly lower in the fluconazole group (3.7%) than in those admitted during the earlier era (18.1%).
Summing up, Dr. Manzoni added that using the prophylactic approach "other premature infants destined to get severely sick and to have a poor outcome could avoid severe systemic fungal illness and could have a better follow-up."