Introduction Prophylactic anti fungal use reduces the incidence of colonisation and invasive fungal infection in premature neonates. We surveyed the current regimens for the use of antifungal prophylaxis in the tertiary neonatal units across the UK.
Method We enquired about indications for use, drug of choice for prophylaxis, criteria for stopping the prophylaxis and drug used for suspected or proven fungal infection.
Results Out of 52 units 42 [81%] responded. 7 units [17%] did not use any prophylaxis. 26 units [62%] had guidelines on the use of anti fungal prophylaxis. 9 units [21%] used prophylaxis but did not have any guidelines. Of the units using prophylaxis, 43% used birth weight as a criterion ranging from < 750grams to < 1.2kilogram. 51% of units used gestation as a criterion ranging from < 25weeks to < 32 weeks. 20% of units used antibiotic use as their only criterion for starting prophylaxis. 31% used presence of longline as a criterion. Small number of units used abdominal surgery, prolonged intubation, NEC, Candida colonisation, postnatal steroids and ranitidine as a criterion. The commonest drug used for prophylaxis was fluconazole [50%]. 29% of units used nystatin and 12% of units used miconazole gel. 26% of units used the same prophylactic drug when treating suspected or proven fungal infection.
Conclusion Despite evidence of the efficacy of anti-fungal prophylaxis, 17% of tertiary units are not using antifungal prophylaxis for infants at high risk. There remains considerable heterogeneity in indications and the specific antifungal used for prophylaxis.