|
Fluconazole Prophylaxis (Version 1.0 10/24/2005 - 3/4/2008) Background: Systemic Candida infections occur in about 20% of infants <1000g birth-weight with a mortality rate of 30 to 50%. Review of the literature suggests that approximately 80% of these infections can be prevented by Fluconazole prophylaxis. In our experience here at Vanderbilt Fluconozole prophylaxis may prevent 9 of 11 systemic fungal infections per year in infants <26 weeks completed gestational age, with a number needed to treat of approximately 12. The decision was made to start a Fluconazole prophylaxis protocol which will be assessed on a yearly basis.
Protocol: Fluconazole prophylaxis should be instituted in all infants <26 completed weeks gestational age or <750g birth weight, who have been admitted to the Stahlman nursery or VCH within 5 days of age and who require central vascular access. Exclusion: Liver failure Fluconazole dose: 3 mg/kg IV twice weekly starting on DOL 1 for up to 6 weeks Weekly screening of hepatic (GPT, SGOT, direct bilirubin, alkaline phosphatase), hematologic (WBC/diff./plts.), and renal function (BUN, creatinine) while receiving Fluconazole prophylaxis Discontinue Fluconazole prophylaxis: - if infant receives empiric antifungal therapy ≥48 hours - if SGOT or SGPT >250 IU/L - if central vascular catheter is removed. Restart Fluconazole prophylaxis protocol if new central vascular catheter has been placed prior to infant being 6 weeks of age. - if infant is discharged
Send Candida isolate for sensitivities if break-through infection
Literature: Kaufman et al., N Engl J Med 2001;345:1660-6 Kaufman et al., J Pediatr 2005;147:172-9 Healy et al., J Pediatr 2005;147:166-71
October, 2005 Jörn-Hendrik Weitkamp, MD William F. Walsh, MD Archived Versions: None |