Bhat Vishwanath, Fojas Milliecor, Saslow Judy G, Shah Sahil, Sannoh Sulaiman, Amendolia Barbara, Pyon Kee, Kemble Nicole, Stahl Gary, Aghai Zubair H
Pediatrics/Neonatology, Cooper University Hospital-Robert Wood Johnson Medical School, Camden, New Jersey 08103, USA.
Pediatr Int. 2011 Aug;53(4):475-9. doi: 10.1111/j.1442-200X.2010.03286.x.
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.
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.
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.
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.
氟康唑预防用药对预防极低出生体重（ELBW）婴儿的侵袭性念珠菌病有效。作者之前报道，在ELBW婴儿中，氟康唑预防用药会增加胆汁淤积的发生率，这导致他们所在机构将氟康唑预防用药改为每周两次的较低给药频率（LFD）方案。因此，本研究的目的是评估LFD氟康唑预防用药在预防ELBW婴儿侵袭性念珠菌病方面的有效性和安全性。
将接受LFD氟康唑方案（每周两次，最多6周）的ELBW婴儿与接受频繁给药（FD）方案（前2周每72小时一次，接下来2周每48小时一次，最后2周每24小时一次）的婴儿进行比较。比较两组的基线人口统计学特征、念珠菌病危险因素、侵袭性真菌感染率以及胆汁淤积的发生率和严重程度。
接受LFD氟康唑预防用药的婴儿侵袭性念珠菌病发生率（2/104，2%）与接受FD预防用药（0/140，0%；P = 0.4）的婴儿相比，无显著差异。LFD方案下胆汁淤积的严重程度较低，且观察到胆汁淤积发生率有下降趋势。
LFD氟康唑预防用药方案在预防ELBW婴儿侵袭性真菌感染方面有效。LFD方案降低了胆汁淤积的严重程度。
