Twice-weekly fluconazole prophylaxis in premature infants: Association with cholestasis

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...

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Veröffentlicht in:Pediatrics international 2011-08, Vol.53 (4), p.475-479
Hauptverfasser: Bhat, Vishwanath, Fojas, Milliecor, Saslow, Judy G., Shah, Sahil, Sannoh, Sulaiman, Amendolia, Barbara, Pyon, Kee, Kemble, Nicole, Stahl, Gary, Aghai, Zubair H.
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container_end_page 479
container_issue 4
container_start_page 475
container_title Pediatrics international
container_volume 53
creator Bhat, Vishwanath
Fojas, Milliecor
Saslow, Judy G.
Shah, Sahil
Sannoh, Sulaiman
Amendolia, Barbara
Pyon, Kee
Kemble, Nicole
Stahl, Gary
Aghai, Zubair H.
description 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.
doi_str_mv 10.1111/j.1442-200X.2010.03286.x
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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. 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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.</abstract><cop>Melbourne, Australia</cop><pub>Blackwell Publishing Asia</pub><pmid>21040197</pmid><doi>10.1111/j.1442-200X.2010.03286.x</doi><tpages>5</tpages></addata></record>
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source MEDLINE; Wiley Online Library Journals Frontfile Complete
subjects Antifungal Agents - administration & dosage
Antifungal Agents - adverse effects
Antifungal Agents - therapeutic use
Candidiasis, Invasive - epidemiology
Candidiasis, Invasive - prevention & control
Cholestasis - chemically induced
Cholestasis - epidemiology
conjugated hyperbilirubinemia
demography
Drug Administration Schedule
Drug dosages
Female
Fluconazole - administration & dosage
Fluconazole - adverse effects
Fluconazole - therapeutic use
fungal infection
Fungal infections
Humans
Incidence
Infant, Extremely Low Birth Weight
Infant, Newborn
Infant, Premature
Infant, Premature, Diseases - prevention & control
Infants
infection
Linear Models
Male
Premature birth
preterm infants
Preventive medicine
Retrospective Studies
Risk Factors
title Twice-weekly fluconazole prophylaxis in premature infants: Association with cholestasis
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