Abstract
The aim of this study was to review published data on efficacy and safety of prophylaxis and empirical therapy with antifungals in neonates. We have found 37 reports on use of antimycotics in neonates, which had been published by June 2003. Of 37 reports 5 were clinical trials of antifungals for prophylaxis and empirical therapy of invasive candidiasis in neonates: 3 were prospective randomized controlled studies and 2 were prospective descriptive studies. One report represented metaanalysis. Fluconazole was shown to be a single drug that can be used for prophylaxis of invasive candidiasis in preterm and low-birthweight infants. However, at least four problems remain unresolved: drug of choice for the empirical antifungal treatment of invasive mycoses in neonates and optimal dose of fluconazole for primary prophylaxis of invasive candidiasis have not so far been determined; there are no clear recommendations on duration of antifungal prophylaxis; groups of neonatal patients at risk for invasive candidiasis have not yet been defined.
-
1.
Hageman J.R., Stenskle J., Keuler H., Randall E. Candida colonization and infection in very low birth weight infants. J Perinatol 1985;6:251-4.
-
2.
Baley J.E., Kliegman R.M., Boxerbaum B., Fanaroff A.A. Fungal colonization in the very low birth weight infant. Pediatrics 1986;78:225-32.
-
3.
Самсыгина Г.А. Кандидоз новорожденных и детей раннего возраста. Пособие для врачей. М.: Изд-во Минздрава РФ; 1996.
-
4.
Пронина Е.В. Висцеральные и системные формы кандидоза у детей раннего возраста: Автореф. дис. канд. мед. наук. СПб; 1996.
-
5.
Романюк Ф.П. Микозы у детей, вызываемые условнопатогенными грибами: Автореф. дис. д-ра. мед. наук. СПб; 1998.
-
6.
Saiman L., Ludington E., Pfaller M., et al. Risk factors for candidemia in Neonatal Intensive Care Unit patients. The National Epidemiology of Mycosis Survey study group. Pediatr Infect Dis J 2000;19:319-24.
-
7.
Stoll B.J., Gordon T., Korones S.B. Late-onset sepsis in very low birth weight neonates: a report from the National Institute of Child Health and Human Development neonatal research network. J Pediatr 1996;129:63-71.
-
8.
Lee B.E., Cheung P., Robinson J.L., et al. Comparative study of mortality and morbidity in premature infants (<1250 g) with candidemia or candidal meningitis. Clin Infect Dis 1998;27:559-65.
-
9.
El-Masry F.A., Neal T.J., Subhedar N.V. Risk factors for invasive fungal infection in neonates. Acta Paediatr 2002;91:198-202.
-
10.
Leibovitz E. Neonatal candidosis: clinical picture, management controversies and consensus, and new therapeutic options. J Antimicrob Chemother 2002;49 (Suppl 1):69-73.
-
11.
Eccles M., Freemantle N., Mason J. North of England evidence based guidelines development project: methods of developing guidelines for efficient drug use in primary care. Br Med J 1998;316:1232-5.
-
12.
Sims M.E., Yoo Y., You H., et al. Prophylactic oral nystatin and fungal infections in very-low-birth weight infants. Am J Perinatol 1988;5:33-6.
-
13.
Wainer S., Cooper P.A., Funk E., et al. Prophylactic miconazole oral get for the prevention of neonatal fungal rectal colonization and systemic infection. Pediatr Infect Dis J 1992;11:713-6.
-
14.
Chapman R.L., Faix R.G. Persistently positive cultures and outcome in invasive neonatal candidiasis. Pediatr Infect Dis J 2000;19:822-7.
-
15.
Kaufman D., Boyle R., Hazen K.C., et al. Fluconazole prophylaxis against fungal colonization and infection in preterm infants. N Engl J Med 2001;345:1660-6.
-
16.
Kicklighter S.D., Springer S.C., Cox T., et al. Fluconazole for prophylaxis against candidal rectal colonization in the very low birth weight infant. Pediatrics 2001;107:293-8.
-
17.
McGuire W., Clerihew L., Austin N. Prophylactic intravenous antifungal agents to prevent mortality and morbidity in very low birth weight infants (Cochrane Review). In: The Cochrane Library, Issue 1. Oxford: Update Software; 2003.
-
18.
Chapman R.L. Candida infections in the neonate. Curr Opin Pediatr 2003;15:97-102.
-
19.
Kicklighter S.D. Antifungal Agents and Fungal Prophylaxis in the Neonate. Neo Reviews 2002;3:249-55.
-
20.
Neely M.N., Schreiber J.R. Fluconazole prophylaxis in the very low birth weight infant: not ready for prime time. Pediatrics 2001;107:404-5.
-
21.
Saxen H., Hoppu K., Pohjavuori M. Pharmacokinetics of fluconazole in very low birth weight infants during the first two weeks of life. Clin Pharmacol Ther 1993;54:269-77.
-
22.
Wenzl T.G., Schefels J., Hornchen H., Skopnik H. Pharmacokinetics of oral fluconazole in premature infants. Eur J Pediatr 1998;157:661-2.
-
23.
Friedmans S., Richardson S.E., Jacobs S.E., Opbien K. Systemic Candida infection in extremely low birth weight infants: short term morbidity and long-term neurodevelopmental outcome. Eur J Pediatr 2000;19:499-505.
-
24.
Rowen J.L., Tate J.M. Management of neonatal candidiasis. Eur J Pediatr 1998;17:1007-11.
-
25.
Gerard P., Rabalais M.D., Tamisha D., et al. Invasive candidiasis in infants weighing more than 2500 grams at birth admitted to a neonatal intensive care unit. Pediatr Infect Dis J 1996;15:348-52.
-
26.
Evidence-based medicine working group. Evidencebased medicine. A new approach to teaching the practice of medicine. JAMA 1992;258:2420-5.
-
27.
Белоусов Ю.Б. Планирование и проведение клинических исследований лекарственных средств. М.; 2000.
-
28.
Флетчер Р., Флетчер С., Вагнер Э. Клиническая эпидемиология. Основы доказательной медицины. М.: Медиа Сфера; 1998.
-
29.
Worthington H.V., Clarkson J.E., Eden O.B. Interventions for preventing oral candidiasis for patients with cancer receiving treatment (Cochrane Review). In: The Cochrane Library, Issue 1. Oxford: Update Software; 2003.
-
30.
Ascioglu S., Rex J.H., Pauw B., et al. Defining opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplant: an international consensus. Clin Infect Dis 2002;34:7-14.
-
31.
Xanthou M., Valassi-Adam E., Kintsonidou E., Matsaniotis N. Phagocytosis and killing ability of Candida albicans by blood leukocytes of healthy term and preterm babies. Arch Dis Child 1975;50:72-5.
-
32.
Gilbert D.N., Moellering R.C., Sande M.A., editors. The Sanford Guide to Antimicrobial Therapy. 33rd ed. Hyde Park (VT): Antimicrobial Therapy, Inc; 2003.
-
33.
Koren G., Lau A., Klein J., et al. Pharmacokinetics and adverse effects of amphotericin B in infants and children. J Pediatr 1988;113:559-63.