Comparison of the effect of fluconazole with nystatin in the prevention of fungal infections in very low birth weight (VLBW) infants admitted to the NICU of Alzahra Hospital

Abstract

Prophylactic use of fluconazole or nystatin is very common in both children and adults with hematologic malignancies, especially in the field of immunosuppression, but there are few studies on the use of these drugs for the prophylaxis of systemic fungal infections in infants. In the present study, we compared the effect of injectable and oral fluconazole with oral nystatin in very preterm infants (less than 32 weeks gestational age and weighing less than 1500 g) admitted to the NICU. Materials and Methods: This study was a single-blind randomized clinical trial. After collecting demographic data including infant sex, gestational age, birth weight and other neonatal characteristics, infants were divided into one of the following two groups based on a random table of numbers: 1) Injectable fluconazole at a dose of 3 mg / kg twice a week and in case of intravenous route, continue with oral fluconazole 6 mg / kg twice a week for 4 weeks or at the time of discharge, and 2) administer oral nystatin one hundred thousand units (1 ml) in the form of a suspension every eight hours for four weeks or discharge time. In this evaluation, two outcomes were identified and compared in two groups, which are: 1) invasive fungal infection (positive culture of blood, urine or cerebrospinal fluid as primary sterile areas), 2) evaluation of mortality due to invasive fungal infection (occurrence of mortality after positive blood culture or evidence of systemic fungal infection), finally, the respective outcomes were compared between the two groups. Results: The mortality rate was 1 in the nystatin group and 1 in the fluconazole group (P = 0.999); In each group, three people had a fungal infection, all of which were urinary tract infections; The comparison of invasive infection in the study participants was not statistically significant (P = 0.999).