Hello everyone

We are trying to modernize our approach to fluconazole prophylaxis.

I reviewed some US units data that only use for babies <26 weeks and <750g or <750g with 2-3 risk factors like NEC, prolonged antibiotics use,mechanical ventilation, steroids and central lines

Our unit has <5% Invasive fungal infections so trying to see if anyone has other guidelines or publications they can recommend and are willing to share

Thank you

Swedish guidelines are Fluconazole 3 mg/kg every 3 days in <27W with central lines or / and during treatment with antibiotics. To be removed when neither is present.

Can also be considered in cases where broad spectrum antibiotics are used in <30W when suspected intentestinal injury (or recent surgery).

References are here, newest publication from 2017:

https://pubmed.ncbi.nlm.nih.gov/28285752/

https://pubmed.ncbi.nlm.nih.gov/27298330/

https://pubmed.ncbi.nlm.nih.gov/27350534/

https://pubmed.ncbi.nlm.nih.gov/17943803/

Thank you;so gestational age line and antibiotics seem to be determinants. appreciate the literature as well

Our guidelines (a mid-size hospital in Israel with a 25-bed NICU) also instruct to give 3 mg/kg every 72 hours for eligible infants and decision to treat is based on the presence of a central line of any kind as a primary determinant and on corrected age/birth weight as a secondary determinant. There are other secondary determinants if the above criteria are negative (NEC diagnosis, prolonged treatment with broad-spectrum antibiotics), see the attached diagram.

Here are our references:

1. Rolnitsky, A., Levy, I., Sirota, L., Shalit, I., & Klinger, G. (2012). Targeted fluconazole prophylaxis for high-risk very low birth weight infants. European journal of pediatrics, 171(10), 1481–1487. https://doi.org/10.1007/s00431-012-1760-2

2. Pappas, P. G., Kauffman, C. A., Andes, D. R., Clancy, C. J., Marr, K. A., Ostrosky-Zeichner, L., Reboli, A. C., Schuster, M. G., Vazquez, J. A., Walsh, T. J., Zaoutis, T. E., & Sobel, J. D. (2016). Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 62(4), e1–e50. https://doi.org/10.1093/cid/civ933

3. Ericson, J. E. et al. (2016). Fluconazole Prophylaxis for the Prevention of Candidiasis in Premature Infants: A Meta-analysis Using Patient-level Data. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 63(5), 604–610. https://doi.org/10.1093/cid/ciw363

4. Rios, J., Camargos, P., Corrêa, L. P., & Romanelli, R. (2017). Fluconazole prophylaxis in preterm infants: a systematic review. The Brazilian journal of infectious diseases : an official publication of the Brazilian Society of Infectious Diseases, 21(3), 333–338. https://doi.org/10.1016/j.bjid.2017.01.008

5. Ericson, J. E., & Benjamin, D. K., Jr (2014). Fluconazole prophylaxis for prevention of invasive candidiasis in infants. Current opinion in pediatrics, 26(2), 151–156. https://doi.org/10.1097/MOP.0000000000000060

6. Zhang, D., Xie, D., He, N., Wang, X., Dong, W., & Lei, X. (2021). Prophylactic Use of Fluconazole in Very Premature Infants. Frontiers in pediatrics, 9, 726769. https://doi.org/10.3389/fped.2021.726769

7. Fanaroff & Martin's, Neonatal-Perinatal Medicine, Diseases of the Fetus and Infant, 11th Edition Pages 825-827

In our unit we have very few cases of Candida sepsis, so we really dont ue fluconazloe prophylaxis. we have a infectious committe and they check the rowth in cultures everyday, so if there is any suspicious of growing we start treatment.