Twice weekly fluconazole prophylaxis for prevention of invasive Candida infection in high-risk infants of <1000 grams birth weight.
OBJECTIVE
We tested the hypothesis that twice weekly prophylactic dosing of fluconazole prevents invasive candidiasis without promoting resistant Candida species in high-risk, preterm infants.


METHODS
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.
Kaufman
David
D
Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia 22908, USA. dak4r@virginia.edu
Boyle
Robert
R
Hazen
Kevin C
KC
Patrie
James T
JT
Robinson
Melinda
M
Grossman
Leigh B
LB
D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002176:Candida albicans / Q000187:drug effects / Q000302:isolation & purification; D002177:Candidiasis / Q000517:prevention & control*; D002405:Catheterization, Central Venous; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage / Q000627:therapeutic use*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D007442:Intubation, Intratracheal; D008297:Male; D008826:Microbial Sensitivity Tests; D012307:Risk Factors
D000935:Antifungal Agents; D015725:Fluconazole