Twice-weekly fluconazole prophylaxis in premature infants: Association with cholestasis
Article first published online: 18 AUG 2011
© 2011 The Authors. Pediatrics International © 2011 Japan Pediatric Society
Volume 53, Issue 4, pages 475–479, August 2011
How to Cite
Bhat, V., Fojas, M., Saslow, J. G., Shah, S., Sannoh, S., Amendolia, B., Pyon, K., Kemble, N., Stahl, G. and Aghai, Z. H. (2011), Twice-weekly fluconazole prophylaxis in premature infants: Association with cholestasis. Pediatrics International, 53: 475–479. doi: 10.1111/j.1442-200X.2010.03286.x
- Issue published online: 18 AUG 2011
- Article first published online: 18 AUG 2011
- Accepted manuscript online: 29 OCT 2010 11:54AM EST
- Received 15 December 2009; revised 4 October 2010; accepted 7 October 2010.
- conjugated hyperbilirubinemia;
- fungal infection;
- preterm infants
Background: Fluconazole prophylaxis is effective in preventing invasive candidiasis in extremely low-birthweight (ELBW) infants. The authors previously reported an increased incidence of cholestasis with fluconazole prophylaxis in ELBW infants, which led to fluconazole prophylaxis being changed to a less frequent dosing (LFD) schedule of twice a week at their institution. The purpose of the present study was therefore to evaluate the effectiveness and safety of LFD fluconazole prophylaxis in preventing invasive candidiasis in ELBW infants.
Methods: ELBW infants who received the LFD regimen of fluconazole (twice a week for up to 6 weeks) were compared with infants who received the frequent dosing (FD) schedule (every 72 h for first 2 weeks, every 48 h for next 2 weeks and every 24 h for the final 2 weeks). The two groups were compared for baseline demographics, risk factors for candidiasis, the rate of invasive fungal infection and the incidence and severity of cholestasis.
Results: There was no significant difference in the incidence of invasive candidiasis in infants who received the LFD (2/104, 2%) compared to FD (0/140, 0%; P= 0.4) fluconazole prophylaxis. The severity of cholestasis was lower and a trend towards decreased incidence of cholestasis was observed on the LFD schedule.
Conclusion: The LFD regimen of fluconazole prophylaxis is effective in preventing invasive fungal infection in ELBW infants. The severity of cholestasis was decreased with the LFD schedule.