• Tushar B Parikh, Ruchi N Nanavati, Chandrakant V Patankar, Suman Rao, Kishore Bisure, Rekha H Udani, and Preeti Mehta.
• Department of Neonatology, KEM Hospital and Seth GS Medical College, Mumbai 400 012, India. tbparikh@rediffmail.com
• Indian Pediatr. 2007 Nov 1; 44 (11): 830-7.

BackgroundFungal infections are common cause of morbidity and mortality in very low birth weight InfantsObjectivesTo evaluate the efficacy of prophylactic Fluconazole in preventing fungal colonization and invasive fungal infection in VLBW infants.DesignProspective, randomized, double blind placebo controlled clinical trial.SettingTertiary level Neonatal intensive care unit.Subjects120 preterm infants with birth Weight < 1500 g.InterventionInfants were randomly assigned during first three days to receive either Fluconazole or placebo till 28 days or less if, discharged or died earlier. Weekly surveillance cultures from groin, oropharynx, rectum and blood were collected in all patients. Fungal isolates were typed based on standard microbiologic techniques. Liver enzymes were monitored.ResultsBaseline risk factors for fungal infection in Fluconazole and Placebo groups were similar. Fungal colonization was seen in 30 infants (50%) in the placebo group and 11 infants (19%) in the Fluconazole group (P <0.001). Fungal colonization at rectum, groin and oropharynx was less in fluconazole groups. Fluconazole group showed significantly lower colonizations with Candida albicans but not with C. glabrata. Invasive infection was seen in 15 (25%) infants in Placebo group and 16 (26.7%) infants in Fluconazole group (P = 0.835). Various non-albicans Candida were responsible for 96.8% cases of invasive fungal infection (Candida glabrata 71%, C. parapsilosis 14.7% and C. tropicalis 9.6%). No significant hepatotoxicity was noticed during Fluconazole therapy.ConclusionProphylactic fluconazole during the first four weeks of life is effective in reducing fungal colonization but not invasive infection in VLBW infants.

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