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Fluconazole prophylaxis in neonates
  1. Claudia Pansieri1,
  2. Chiara Pandolfini1,
  3. Evelyne Jacqz-Aigrain2,3,4,
  4. John van den Anker5,6,7,
  5. Maurizio Bonati1
  1. 1Laboratory for Mother and Child Health, Department of Public Health, IRCCS-Istituto di Ricerche Farmacologiche “Mario Negri”, Milan, Italy
  2. 2Service de Pharmacologie Pédiatrique, AP-HP, Hôpital Robert Debré, Paris, France
  3. 3Université Paris Diderot, Sorbonne Paris Cité, France
  4. 4INSERM, CIC1426, Hôpital Robert Debré, Paris, France
  5. 5Division of Pediatric Clinical Pharmacology, Children's National Medical Center, Washington, DC, USA
  6. 6Department of Paediatric Pharmacology, University Children's Hospital Basel, Basel, Switzerland
  7. 7Intensive Care, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
  1. Correspondence to Dr Maurizio Bonati, Department of Public Health, Laboratory for Mother and Child Health, IRCCS-Istituto di Ricerche Farmacologiche “Mario Negri”, Via La Masa 19, 20156, Milan, Italy; maurizio.bonati{at}marionegri.it

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Progressive changes in clinical practice have improved the survival of even the most vulnerable neonates, such as those born preterm or with a very low birth weight (VLBW). Frequent contacts with healthcare workers, invasive procedures, early exposure to large scale antibiotics and immature immune systems, however, can cause additional, healthcare related, nosocomial infections.

It is estimated that 2.5% of all bloodstream infections occurring in VLBW infants in neonatal intensive care units (NICUs) have a fungal aetiology.1 Candida species (mainly Candida albicans and Candida parapsilosis) are the third most commonly isolated pathogens in the nursery, acquired vertically from the mother or horizontally from the NICU environment, with an estimated incidence of 1.6%–9% in VLBW and 10%–16% in extremely low birthweight (ELBW) infants.2 Candida colonisation is a primary risk factor for the development of invasive candidiasis, estimated to be three times more common in infants born <26 weeks of gestation or with a <750 g birth weight than in infants with 750–1000 g birth weights.3

Antifungal prophylaxis has been proposed to reduce mortality in this vulnerable population, and fluconazole is emerging as the drug of choice because of its ability to treat more than 90% of Candida species isolates, its high oral bioavailability, and its established safety and tolerability profiles. Fluconazole is currently approved by the European Medicines Agency (EMA) and the Food and Drug Administration for use in adults for the treatment of vaginal candidiasis, oropharyngeal and oesophageal candidiasis, and cryptococcal meningitis. Additionally, it is approved by the EMA for the treatment, …

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