Fluconazole Prophylaxis

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 <27 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 <27 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

Discontinue Fluconazole prophylaxis:

• after completion of 6 weeks of age

• 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

For a copy of the published protocol, Click Here

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