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ARTICLES:
Paolo Manzoni, Riccardo Arisio, Michael Mostert, MariaLisa Leonessa, Daniele Farina, Maria Agnese Latino, and Giovanna Gomirato
Prophylactic Fluconazole Is Effective in Preventing Fungal Colonization and Fungal Systemic Infections in Preterm Neonates: A Single-Center, 6-Year, Retrospective Cohort Study
Pediatrics 2006; 117: e22-e32 [Abstract] [Full text]
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[Read P3R] Fluconazole antifungal prophylaxis - why is it necessary?
David W Cartwright   (11 January 2006)

Fluconazole antifungal prophylaxis - why is it necessary? 11 January 2006
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David W Cartwright,
Director of Neonatology
Royal Brisbane and Women's Hospital, Brisbane, Australia

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Re: Fluconazole antifungal prophylaxis - why is it necessary?

David_Cartwright{at}health.qld.gov.au David W Cartwright

The study by Manzoni et al (1) of 464 babies of <1500g birthweight is of interest. However, it raises the question of differences between neonatal centres, and their significance. I have no interest in Fluconazole fungal prophylaxis, as we have no need for it. In the same issue of your journal, Benjamin et al (2) describe a 7% incidence of Candidiasis in a large cohort of <1000g birthweight babies. In the time period addressed by Manzoni et al (1) (1998 – 2003), our neonatal unit in Brisbane, Australia admitted 1127 babies of <1500g birthweight, with 433 of those being of <1000g birthweight. We grew Candida from the blood stream of only two of those (0.18%), of 520g and 585g birthweight respectively, one in 1998 and the other in 1999. Eleven babies of all birthweights in that time received systemic antifungal medication for this and other indications such as heavy colonisation of endotracheal tube or skin, or growth from the peritoneal cavity. This is a dramatically lower incidence of Candidiasis than that experienced by the authors of either of these reports.

Why is this so? We do use antifungal prophylaxis of oral and topical nystatin for all babies receiving parenteral nutrition (741 of those above), which is delivered by peripherally inserted central venous catheter (731 of those) or umbilical venous line (665 – many had both), but I doubt that fully explains the difference. Is there a fundamental difference in our local flora? Is there a difference in our general management practices that discourages the presence or growth of Candida? The ‘why is it so?’ may be the unanswerable question, but if it were answerable, and our experience was transportable, it would be far better than routine exposure to a systemically delivered powerful antifungal agent.

1. Manzoni P, Arisio R, Mostert M et al. Prophylactic Fluconazole Is Effective in Preventing Fungal Colonization and Fungal Systemic Infections in Preterm Neonates: A Single-Centre, 6-Year, Retrospective Cohort Study. Pediatrics. 2006;117:e22-e32

2. Benjamin DK, Stoll B, Fanaroff A et al. Neonatal Candidiasis Among Extremely Low Birth Weight Infants: Risk Factors, Mortality Rates, and Neurodevelopmental Outcomes at 18 to 22 Months. Pediatrics. 2006;117:84-92

Conflict of Interest:

None declared