Twice Weekly Fluconazole Prophylaxis for Prevention of Invasive Candida Infection in High-risk Infants of <1000 Grams Birth Weight - 21/08/11

Doi : 10.1016/j.jpeds.2005.03.036

David Kaufman, MD ^⁎ , Robert Boyle, MD, Kevin C. Hazen, PhD, James T. Patrie, MS, Melinda Robinson, RN, Leigh B. Grossman, MD
From the Departments of Pediatrics, Pathology and Microbiology, and Health Evaluation Sciences, University of Virginia School of Medicine, Charlottesville, Virginia

Reprint requests: Dr David Kaufman, Division of Neonatology, Department of Pediatrics, Box 800386, University of Virginia Health System, Charlottesville, VA 22908.

See editorial, p 135, and related articles, p 156, p 162, and p 166.

Abstract

Objectives

We tested the hypothesis that twice weekly prophylactic dosing of fluconazole prevents invasive candidiasis without promoting resistant Candida species in high-risk, preterm infants.

Study design

We compared our previous dosing schedule (Group A) to a less frequent dosing schedule of twice a week (Group B) of fluconazole prophylaxis for up to 6 weeks in a prospective, randomized, double-blind clinical trial in preterm infants weighing <1000 grams at birth and with an endotracheal tube and/or central vascular catheter over a 24-month period. Weekly surveillance cultures were obtained on study patients.

Results

Candida colonization was documented in 5 (12%) of 41 Group A and in 4 (10%) of 40 Group B infants. Candida sepsis developed in two (5%) of Group A and one (3%) of Group B infants (risk difference, −0.02; 95% confidence interval, −0.14-0.10; P=.68). All fungal isolates remained sensitive to fluconazole, and no drug side effects were documented.

Conclusions

Twice weekly dosing of prophylactic fluconazole can decrease Candida colonization and invasive infection, cost, and patient exposure in high-risk, preterm infants weighing <1000 grams at birth. We speculate that lower and less frequent dosing may delay or prevent the emergence of antifungal resistance.

Le texte complet de cet article est disponible en PDF.

Mots-clés : ALT, AST, MIC, NICU