Candidia Infection in Neonates

Publication: 01/03/2009  --
Last review: 07/06/2017  
Next review: 01/06/2020  
Clinical Guideline
CURRENT 
ID: 1552 
Approved By: Improving Antimicrobial Prescribing Group 
Copyright© Leeds Teaching Hospitals NHS Trust 2017  

 

This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Guideline for Antimicrobial Prophylaxis of Candidia Infection in Neonates

Summary
Candidia Infection in Neonates

Summary table of routine recommendations

Procedure/criteria

Prophylaxis recommended

Evidence level

Prophylaxis intended to reduce

NNT

Antimicrobial dose/route

Routine

Adverse reaction to first line

All neonates with either birth weight < 1000g or gestation of <28 weeks

YES
Day 1-42 or until all central intravenous access removed

 A

Invasive Candida infection

 

1 mL Nystatin oral suspension 100,000 units/mL 8 hourly

0.5mL into mouth, remainder down gastric tube.

Fluconazole electronic Medicines Compendium information on Fluconazole

Week 1-2:
Fluconazole electronic Medicines Compendium information on Fluconazole 6mg/kg/dose iv or po once every 3rd day

Week 3-4
Fluconazole electronic Medicines Compendium information on Fluconazole 6mg/kg/dose iv or po once every 2nd day

Week 4-5 
Fluconazole electronic Medicines Compendium information on Fluconazole 6mg/kg/dose iv or po daily

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Background
Invasive fungal infection accounts for approximately 10% of late-onset infection in very preterm infants. Mortality and morbidity are high. Prophylaxis against infection has been shown to be effective although practices vary widely.As well as medical prophylaxis, measures aimed at reducing the incidence of invasive candidiasis focused on good infection control policy adherence and prompt removal of infected devices remain valid.

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Treatment

Special antimicrobial prophylaxis recommendations

Nystatin is an attractive choice for prophylaxis as it is easily administered and has no systemic absorption. Colonisation of the mouth and gastrointestinal tract most likely to be the source for development of invasive candidiasis in preterm infants.

Nystatin prophylaxis significantly reduces the incidence of invasive candidiasis and mortality rates in extremely low birth weight infants as effectively as intravenous fluconazole. A recent prospective RCT compared nystatin with fluconazole for the prevention of fungal colonisation and invasive fungal infection in very low birth weight (VLBW) neonates. The incidence of invasive fungal infection was 4.3% in the nystatin group and 3.2% in the fluconazole group, as compared with 16.5% in the control group. There were no differences in fungal colonisation and invasive fungal infection between the nystatin and fluconazole groups.

Prophylaxis against Candida infection should be commenced on day 1 in all neonates with either birth weight < 1000g or gestation of <28 weeks, and continued until all intravenous central lines have been removed, or six weeks of age whichever is sooner.

Administration
1mL Nystatin oral suspension to be administered by mouth (0.5mL) and remainder into gastric tube followed by 1mL air bolus down gastric tube to ensure delivery into stomach.

Monitoring

No monitoring is required as there is no systemic absorption.

Adverse Effects

  • Occasional oral irritation
  • Nausea

A. Meta-analyses randomised controlled trials/systematic reviews of RCTs
B. Robust experimental or observational studies
C. Expert consensus.
D. LTHT Consensus [no national guidelines exist, guidelines from different learned bodies   contradict each other, or no evidence exists]

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Provenance

Record: 1552
Objective:
Clinical condition:

Candida prophylaxis in neonates

Target patient group: Neonates
Target professional group(s): Pharmacists
Secondary Care Doctors
Adapted from:

Evidence base

  1. Aydemir C, Oguz S,1 Dizdar E et al.Randomised controlled trial of prophylactic fluconazole versus nystatin for the prevention of fungal colonisation and invasive fungal infection in very low birth weight infants. Arch Dis Child Fetal Neonatal Ed 2011;96:F164–F168
  2. Isaacs, D. Fungal prophylaxis in very low birth weight neonates: nystatin, fluconazole or nothing? Current Opinion in Infectious Diseases: June 2008 - Volume 21 - Issue 3 - p 246-250
  3. Sims ME, Yoo Y, You H, Salminen C, Walther FJ. Prophylactic oral nystatin and fungal infections in very-low-birthweight infants. Am J Perinatol. 1988 Jan;5(1):33-6.
  4. Ganesan K, Harigopal S, Neal T, Yoxall CW. Prophylactic oral nystatin for preterm babies under 33 weeks’ gestation decreases fungal colonisation and invasive fungaemia. Arch Dis Child Fetal Neonatal Ed 2009;94:F275-F278

Approved By

Improving Antimicrobial Prescribing Group

Document history

LHP version 1.0

Related information

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