Infection in Preterm Infants Treatment

Infection in Preterm Infants Treatment 

Introduction: Invasive candidal infections are a major cause of illness and death among preterm infants. Efforts to reduce fungal colonization might help to prevent invasive infections. The safety and efficacy of prophylactic fluconazole for the prevention of fungal colonization and invasive infections were assessed.

 Methods: The randomized, controlled trial included 100 preterm infants with birth weights of less than 1000 g. At entrollment during the first 5 days of life, the infants were randomly assigned to receive 6 weeks of IV fluconazole or placebo. The fluconazole dosage was 3 mg/kg every third day for the first 2 weeks, then every other day during weeks 3 and 4, then every day during weeks 5 and 6. Weekly cultures were performed to monitor for fluconazole resistance.

Results: The 2 groups were similar in their baseline characteristics, including risk factors for fungal infaction. Over the 6 weeks of the study, the fugal colonization rate was 60% in the placebo group versus 22% in the fluconazole group. The corresponding difference in risk was 0.38 (95% CI, 0.18-0.56). Twenty percent of infants in the placebo group had invasive fungal infections associated with fungal isolates identified in blood, urine, or CSF. In contrast, no infant in the fluconazole group had an invasive infection, which yielded a risk difference of 0.20 (95% CI, 0.04-0.36). No changes were found in the sensitivity to fluconazole, and no adverse effects of the fluconazole treatment occurred.

Conclusions: For preterm infants with birth weights of less than 1000 g, prophylactic fluconazole can significantly reduce the risk of fugal colonization and invasive fungal infections. No evidence of development of fluconazole resistance was present in this 6-week study. The study provides no information on the effects of fluconazole for infants requiring vascular access or endotracheal incubation beyond 6 weeks of age.