Fluconazole Effectiveness in Preventing Invasive Fungal Infection in Very Low Birth Weight Infants: Systematic Review and Meta-analysis

systematic review and meta-analysis

Authors

  • Fonny Cokro Department of Pharmacy, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia
  • Lorensia Yolanda Department of Pharmacy, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia ,
  • Shelly Caroline Department of Pharmacy, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia ,

DOI:

https://doi.org/10.35814/jifi.v20i1.1035

Keywords:

antifungal, fluconazole, infant, invasive fungal infection, prevention and control, very low birth weight

Abstract

Fungal infections in neonates, especially in Very Low Birth Weight (VLBW) infants, are mostly caused by Candida species and may lead to morbidity and mortality. A systematic review and a meta-analysis were conducted to determine the extent to which fluconazole, an antifungal prophylactic, was effective and safe to use in VLBW or premature infants in preventing Invasive Fungal Infection (IFI), by including Randomized Controlled Trials (RCTs) carried out worldwide. The investigation started with searching process through publication databases: MEDLINE, Cochrane, ScienceDirect, and Garuda, for Randomized Controlled Trials (RCTs) that compared the prophylactic effects of fluconazole and placebo on IFI in VLBW infants. The selected eight RCT studies indicated that, compared to placebo, fluconazole accounted for 68% risk reduction of overall fungal colonization (RR=0.32; 95% confidence interval [CI]=0.24-0.42, p=0.00001, I-square=0%) and 60% risk reduction of IFI (RR=0.40; 95%[CI]=0.22-0.72, I-square=56%, p=0.002). However, fluconazole did not significantly reduce mortality in VLBW infants (RR=0.79; 95%[CI]=0.60-1.03; p=0.08, I-square=0%). Also, regarding its safety, fluconazole prophylaxis did not result in significant elevations of SGOT/SGPT levels (RR=1.22; 95%[CI]=0.50-3.00, p=0.66, I-square=0%) nor cause intestinal perforation (RR=0.96; 95%[CI]=0.25-3.68, p=0.96, I-square=59%). Fluconazole is an effective prophylaxis agent against invasive fungal infection when given to preterm infants with birth weight <1500, but not proven in reducing the mortality incidence in VLBW infants.

References

Downloads

Published

2022-04-25

Issue

Vol. 20 No. 1 (2022): JIFI

Section

Articles

License

Licencing
All articles in Jurnal Ilmu Kefarmasian Indonesia are an open-access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License which permits unrestricted non-commercial used, distribution and reproduction in any medium.

This licence applies to Author(s) and Public Reader means that the users mays :

  • SHARE:
    copy and redistribute the article in any medium or format
  • ADAPT:
    remix, transform, and build upon the article (eg.: to produce a new research work and, possibly, a new publication)
  • ALIKE:
    If you remix, transform, or build upon the article, you must distribute your contributions under the same license as the original.
  • NO ADDITIONAL RESTRICTIONS:
    You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.

It does however mean that when you use it you must:

  • ATTRIBUTION: You must give appropriate credit to both the Author(s) and the journal, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.

You may not:

  • NONCOMMERCIAL: You may not use the article for commercial purposes.

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.