Chemoprophylaxis of neonatal fungal infections in very low birthweight infants: efficacy and safety of fluconazole and nystatin

  title={Chemoprophylaxis of neonatal fungal infections in very low birthweight infants: efficacy and safety of fluconazole and nystatin},
  author={Christopher C. Blyth and Federica Barzi and Katherine A Hale and David Isaacs},
  journal={Journal of Paediatrics and Child Health},
  • C. BlythF. Barzi D. Isaacs
  • Published 1 September 2012
  • Medicine, Biology, Chemistry
  • Journal of Paediatrics and Child Health
Aim:  To review the use of antifungal chemoprophylaxis to prevent neonatal invasive fungal infections (IFI) in very low birthweight infants (VLBW <1500 g). 

Oral nystatin prophylaxis to prevent systemic fungal infection in very low birth weight preterm infants: a randomized controlled trial

Nystatin is effective and safe as an antifungal prophylactic medication in reducing colonization rates in the study population and showed a potential protective effect against SFI among VLBW preterm infants.

Current Epidemiology and Management of Invasive Candidiasis in Infants

While available antifungal agents appear to be effective in the treatment of IC in infants, knowledge of the optimal type, dose, and duration of antifundal therapy is limited by the low number of available infant studies.

[Efficacy and safety of fluconazole in prophylaxis of invasive fungal infections in very low birth weight infants: a Meta analysis].

  • X. XiaLu LinHua Zi-yu
  • Medicine, Biology
    Zhongguo dang dai er ke za zhi = Chinese journal of contemporary pediatrics
  • 2020
Prophylactic fluconazole can effectively and safely prevent invasive fungal infection in VLBW infants, even at a small dose.

Invasive fungal infections in newborns and current management strategies

Early initiation of enteral feeds with human milk, decreasing dependence on catheters and avoidance of antacids, steroids and broad-spectrum antibiotics are the recommended preventive measures for invasive fungal infections in newborns.

Fluconazole Administration Leading to Anaphylactic Shock in a Preterm Newborn

This is believed to be the first anaphylaxis case in newborns caused by fluconazole in literature and Clinicians should be aware of the possibility of this potentially fatal adverse effect occurring with intravenous flu Conazole.

Treatment of fungal infections: an update

Future strategies to reduce neonatal morbidity and mortality derived from invasive fungal infections include new echinocandins not yet approved for neonatal use and other adjuvant treatments as intravenous immunoglobulin, lactoferrin or probiotics.

Fluconazole prophylaxis against invasive candidiasis in very low and extremely low birth weight preterm neonates: a systematic review and meta-analysis

Mortality was significantly decreased in a meta-analysis of studies using different fluconazole prophylaxis regimens and a significant decrease in the incidence of IC-associated mortality in ELBW infants using the same fluconzole proPHylaxis schedules.

Neonatal Bacterial and Fungal Infections

Infections represent a major cause of mortality and morbidity in the neonatal intensive care units (NICUs), where reported incidences range from 6% to 33% and up to 40% in neonates born before 28 weeks’ gestational age or with birth weight < 1000 g.

Risk Factors for Invasive Fungal Infection in Premature Infants: Enhancing a Targeted Prevention Approach.

Gestational age and male gender are risk factors for the development of ICI, whereas vaginal delivery and antibiotics during the first week of life further increase the incidence in the more premature infants.



Systemic antifungal prophylaxis for very low birthweight infants: a systematic review

Systematic review and meta-analysis of four randomised controlled trials suggest that prophylactic fluconazole reduces the incidence of invasive fungal infection in very low birthweight infants.

Fungal prophylaxis in very low birth weight neonates: nystatin, fluconazole or nothing?

  • D. Isaacs
  • Medicine, Biology
    Current opinion in infectious diseases
  • 2008
Oral nystatin prophylaxis is inexpensive, effective and nontoxic and should be used routinely for babies of birth weight less than 1500 g, with reasonable evidence that oral nyStatin is effective in preventing fungal infections and at the same time it is inexpensive and well tolerated.

Fluconazole for prophylaxis against candidal rectal colonization in the very low birth weight infant.

Prophylactic administration of fluconazole to the VLBW infant for the first 28 days of life is safe and results in a decreased risk of rectal colonization by candidal species.

Prophylactic oral nystatin and fungal infections in very-low-birthweight infants.

It is concluded that prophylactic administration of oral nystatin reduces fungal colonization and infection in very-low-birthweight infants.

Oral nystatin prophylaxis and neonatal fungal infections

Antifungal prophylaxis with oral nystatin was associated with a significantly lower incidence of fungal infection compared with no prophYLaxis, and the incidence of neonatalFungal infection was low in Australia and New Zealand, even without antifungals.

Comparison of fluconazole and nystatin oral suspensions for prophylaxis of systemic fungal infection in very low birthweight infants.

Although the results cannot justify any conclusion about the relative efficacy of fluconazole versus nystatin in prevention of SFI, the significantly higher mortality rate in the nyStatin group raises questions about therelative safety of this medication.

Selective fluconazole prophylaxis in high-risk babies to reduce invasive fungal infection

Selective antifungal prophylaxis has reduced invasive fungal sepsis in one NICU without evidence of fluconazole resistance emerging.

Oral nystatin prophylaxis to prevent invasive candidiasis in Neonatal Intensive Care Unit

Oral nystatin prophylaxis significantly reduced the invasive candidiasis in extremely low‐birth weight (ELBW) and very low‐ Birth weight (VLBW) infants.

Challenging issues in neonatal candidiasis

  • D. Kaufman
  • Medicine, Biology
    Current medical research and opinion
  • 2010
In an era of quality improvement and ‘getting to zero,’ neonatal candidiasis is ripe for evidence-based initiatives, and antifungal prophylaxis has been shown to nearly eliminate infection-related mortality.

Fluconazole prophylaxis against fungal colonization and invasive fungal infection in very low birth weight infants.

Prophylactic fluconazole during the first four weeks of life is effective in reducing fungal colonization but not invasive infection in VLBW infants.