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Preterm infants weighing less than 1500 g at birth are vulnerable to fungal infections that can be lethal. Some neonatal intensive care units already give fluconazole prophylaxis to their babies, a strategy that worked well in the latest European trial.
In eight Italian units, four to six weeks of fluconazole reduced the risk of invasive fungal infections, which occurred in 2.7% (3/112) of babies given 6 mg/kg, 3.8% (4/104) of babies given 3 mg/kg, and 13.2% (14/106) of babies given a placebo (P=0.005 for both active groups compared with placebo). Candida albicans and Candida parapsilosis were the most common infecting species. Prophylaxis with fluconazole also helped prevent colonisation with Candida, but it had no effect on progression from colonisation to infection. Mortality rates were comparable in all three groups (8.0% (9/112) v 8.7% (9/104) v 9.4% (10/106))
Emerging resistance was not a problem in this short term trial, but the authors say it's too early to discount the possibility of later problems in neonatal intensive care units that routinely use fluconazole prophylaxis.
Because colonisation and infection rates are variable, units will need to adapt their prevention strategies locally. Other important measures include rigorous hand washing and prevention of vertical transmission by treating vaginal candidiasis in the mothers, say the authors.