Prophylactic oral antifungal agents to prevent systemic candida infection in preterm infants

Austin, Nicola; Darlow, Brian A

doi:10.1002/14651858.cd003478.pub2

Cited by 31 publications

(23 citation statements)

References 24 publications

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“…[25][26][27] An initial fungal colonization at a peripheral site in the first days of life may well be better managed by topical rather than systemic antifungal agents, as it mostly depends on the inefficiency of the host barrier defense. However, this treatment cannot be proposed for all of the potential sites in every preterm neonate, because it is unknown which sites will become colonized, and some sites cannot be treated topically.…”

Section: Discussionmentioning

confidence: 99%

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Prophylactic Fluconazole Is Effective in Preventing Fungal Colonization and Fungal Systemic Infections in Preterm Neonates: A Single-Center, 6-Year, Retrospective Cohort Study

Manzoni

Arisio²,

Mostert³

et al. 2006

Pediatrics

140

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OBJECTIVE. Despite the promising preliminary results observed in extremely low birth weight (ELBW) populations, the use of fluconazole to prevent fungal colonization and infection in preterm neonates in the NICU is still an open question and not yet recommended as a standard of care. We have reviewed our 6-year series to assess the effectiveness and safety of this form of prophylaxis.METHODS. This retrospective study consisted of 465 neonates who weighed Ͻ1500 g at birth and were admitted to our NICU in the period 1998 -2003. Those who were born between 1998 and 2000 and did not receive fluconazole prophylaxis (group A, n ϭ 240) were compared with those who were born between 2001 and 2003 and treated with fluconazole until the 30th day of life (45th for neonates Ͻ1000 g at birth; group B, n ϭ 225). Weekly surveillance cultures were obtained from all patients. Incidence of fungal colonization, incidence of systemic fungal infection (SFI), rate of progression from colonization to infection, and mortality rates attributable to fungi were calculated for both groups and separately for neonates who were Ͻ1000 g (ELBW) and were 1001 to 1500 g (NE-VLBW) at birth.RESULTS. Overall fungal colonization was significantly lower in group B (24.0%) than in group A (43.8%; relative risk [RR]: 0.406; 95% confidence interval [CI]: 0.273-0.605). The same was true of neonates with colonization in multiple sites (2.6% vs 5.8%) and of those with colonization from high-risk sites (5.8% vs 19.2%). SFI incidence was significantly lower in group B (10 of 225 cases; 4.4%) than in group A (40 of 240 cases; 16.7%; RR: 0.233; 95% CI: 0.113-0.447). Reduction of both colonization and SFI in group B was greater in the ELBW neonates and also significant in the NE-VLBW neonates. Rate of progression from colonization to infection was significantly lower in group B (0.17 vs 0.38; RR: 0.369; 95% CI: 0.159 -0.815). Crude mortality rate attributable to Candida species www.pediatrics.org/cgi

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Section: Discussionmentioning

confidence: 99%

“…Two studies showed that oral or intravenous fluconazole 24 and oral nystatin 25,26 can prevent rectal colonization by Candida, whereas topical miconazole oral gel failed to prevent colonization and systemic infection. 27 The efficacy of fluconazole in reducing both colonization and infection in ELBW neonates has been demonstrated in 1 study.…”

mentioning

confidence: 99%

Prophylactic Fluconazole Is Effective in Preventing Fungal Colonization and Fungal Systemic Infections in Preterm Neonates: A Single-Center, 6-Year, Retrospective Cohort Study

Manzoni

Arisio²,

Mostert³

et al. 2006

Pediatrics

140

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“…[7] Fluconazole is the most widely used anti-fungal agent for prophylaxis against ICI. Nystatin is another anti-fungal agent that has been used for prophylaxis of ICI in neonate;89] it is readily available, easy to administer.…”

Section: Introductionmentioning

confidence: 99%

Oral nystatin versus intravenous fluconazole as neonatal antifungal prophylaxis: Non-inferiority trial

et al. 2013

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Background:Fluconazole has shown to be effective in reducing both colonization and invasive Candida infection (ICI) in ELBW neonates; we conducted a randomized trial to compare oral nystatin with intravenous fluconazole for prophylaxis against invasive Candidiasis in high risk neonates.Materials and Methods:By using SPSS, preterm less than 30 weeks gestation and/or birth weight 1200 grams or less assigned to receive either intravenous Fluconazole (6 mg/kg q72 hr for 1st week then q48 h for 6 wks) or oral Nystatin (100,000 unit q8 hr for 6 wks). The medications commenced at one week of age after obtaining the base line investigations and check for Candida colonization by urine culture and rectal swab; subsequently all lab work and the clinical data were monitered regularly. Risk factors were assessed. The data collected prospectively looking for primary end point the invasive Candida infection (ICI) and 2 ndry outcomes include medication safety, tolerance and cost.Results:65 neonate randomly assigned however only 57 neonates comleted the study 33/57 (57%) to intravenous fluconazole group and 24/57 (42%) to oral nystatin group. No differences in birth weights Nystatin (1.15 Kg) Fluconazole (1.01 Kg), gender males (26/57), female (32/57), Gestational age (29.28 vs l28.22) or risk factors between the two groups. Rectal swab Colonization occurred in 2/24 (8%) in Nystatin group and 4/33 (12%) in the Fluconazole group, but none of the neonates developed ICI or side effects, although in the Fluconazole group transient transaminase elevation 2SD standard deviation above the mean was observed. Central line duration was 2 SD above the mean for fluconazole group, The cost of the Fluconazole treated group (7,581 SAR) 106.4 US/pt double the cost of Nystatin treated group (3,375 SAR) 50 US/pt.Conclusion:Intravenous Fluconazole and oral Nystatin at the prophylactic doses are equally effective and safe in preventing (ICI) in preterm neonates, however oral Nystatin is readily available, easily administered with lower cost per neonate.

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“…23 In ill neonates, oral candidiasis may be a step in the pathogenesis of systemic candidiasis, a condition with a high mortality rate. 24 A Cochrane Review by Austin and Darlow 25 indicates that there is insufficient evidence to support the use of prophylactic oral antifungal agents in very low birth weight infants to reduce oral candida. They suggest that reducing oral candida among ill neonates is worthwhile, but that additional studies are needed to determine how this can be accomplished.…”

Section: Discussionmentioning

confidence: 99%

ETCare: a randomized, controlled, masked trial comparing two solutions for upper airway care in the NICU

et al. 2007

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Objective: Small quantities of normal saline are sometimes instilled into the endotracheal tube of intubated neonates, to assist with the removal of thick secretions and maintain patency of the endotracheal tube. However, saline is detrimental to the innate immune system of the upper airway mucosa, rapidly unfolding and inactivating antimicrobial peptides such as LL-37. We previously reported the preparation and feasibility testing of 'ETCare', a low-sodium, physiologically based solution for airway care, and we now report results of a randomized, masked, controlled, two-centered study testing ETCare vs sterile saline among 60 intubated NICU patients.Study Design: Sixty intubated NICU patients were randomized to having their airway care with ETCare vs saline. Three hypotheses were tested: (1) tolerance -patients will tolerate ETCare for airway care as well as they tolerate saline, (2) nosocomial infections -ETCare will result in fewer tracheal aspirates where organisms grow and fewer cases of nosocomial sepsis, and (3) chronic lung disuse -ETCare will result in fewer patients discharged home on supplemental O 2 .Result: Thirty NICU patients with an endotracheal tube in place were randomized to receive their airway care with ETCare, and 30 to receive their care with saline. Only the pharmacist was aware of the randomization; the two solutions were visually indistinguishable and were dispensed in identical syringes. Tolerance of the solutions was similar. The ETCare recipients had trends toward fewer positive blood cultures (odds ratios (OR), 0.48; 95% confidence interval (CI), 0.13 to 1.68), and fewer discharges home on supplemental O 2 (OR, 0.43; 95% CI, 0.14 to 1.32; P ¼ 0.075). Conclusion:On the basis of this study and our previous 10-patient feasibility trial, we maintain that, for airway care, intubated NICU patients tolerate ETCare as well as saline. Data from this study can be used in estimating the sample sizes needed for a phase III trial. We speculate that such a trial will demonstrate that, compared with saline, ETCare will result in fewer nosocomial infections and less chronic lung disease.

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Prophylactic oral antifungal agents to prevent systemic candida infection in preterm infants

Cited by 31 publications

References 24 publications

Prophylactic Fluconazole Is Effective in Preventing Fungal Colonization and Fungal Systemic Infections in Preterm Neonates: A Single-Center, 6-Year, Retrospective Cohort Study

Prophylactic Fluconazole Is Effective in Preventing Fungal Colonization and Fungal Systemic Infections in Preterm Neonates: A Single-Center, 6-Year, Retrospective Cohort Study

Oral nystatin versus intravenous fluconazole as neonatal antifungal prophylaxis: Non-inferiority trial

ETCare: a randomized, controlled, masked trial comparing two solutions for upper airway care in the NICU

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