hi all,

is there any role of giving antifugals iv prophylactically in lbws or vlbws ? if yes which one is preferred?

There are two options for candida prophylaxis

1) Local application of nystatin to the inner cheeks

2) IV Fluconazole

Some selected reading

Ref

Fluconazole prophylaxis against fungal colonization and invasive fungal infection in very low birth weight infants.

Parikh TB, Nanavati RN, Patankar CV, Rao S, Bisure K, Udani RH, Mehta P.

Indian Pediatr. 2007 Nov;44(11):830-7.

LINK TO DOWNLOAD

A multicenter, randomized trial of prophylactic fluconazole in preterm neonates.

Manzoni P, Stolfi I, Pugni L, Decembrino L, Magnani C, Vetrano G, Tridapalli E, Corona G, Giovannozzi C, Farina D, Arisio R, Merletti F, Maule M, Mosca F, Pedicino R, Stronati M, Mostert M, Gomirato G; Italian Task Force for the Study and Prevention of Neonatal Fungal Infections; Italian Society of Neonatology.

N Engl J Med. 2007 Jun 14;356(24):2483-95.

LINK TO DOWNLOAD

Prophylactic oral antifungal agents to prevent systemic candida infection in preterm infants.

Austin NC, Darlow B.

Cochrane Database Syst Rev. 2004;(1):CD003478. Review.

LINK

Prophylactic systemic antifungal agents to prevent mortality and morbidity in very low birth weight infants.

Clerihew L, Austin N, McGuire W.

Cochrane Database Syst Rev. 2007 Oct 17;(4):CD003850. Review.

LINK

Prophylactic oral nystatin for preterm babies under 33 weeks' gestation decreases fungal colonisation and invasive fungaemia.

Ganesan K, Harigopal S, Neal T, Yoxall CW.

Arch Dis Child Fetal Neonatal Ed. 2009 Jul;94(4):F275-8. Epub 2008 Nov 26.

LINK

Emergence of fluconazole resistance in a Candida parapsilosis strain that caused infections in a neonatal intensive care unit.

Sarvikivi E, Lyytikäinen O, Soll DR, Pujol C, Pfaller MA, Richardson M, Koukila-Kähkölä P, Luukkainen P, Saxén H.

J Clin Microbiol. 2005 Jun;43(6):2729-35.

LINK

Fungal infection in a NICU should be very low (see Vermont database). In Center with high incidence an analisys of risk factor inside the NICU should be performed (hygiene protocol); profilaxys could be used until solution of NICU problems causing fungineal high incidence