Therapy and prophylaxis in newborn patients

Fluconazole is the most used drug for antifungal prophylaxis in neonatal population. Despite its effectiveness, sometimes fungal infections occur also in newborn patients undergoing fluconazole prophylaxis: this is mainly due both to biofilm formation in patients who carry a central venous catheter (CVC), a common condi­tion among premature babies, and to the occurrence of an infection by a Candida subspecies with intrinsic resistance to fluconazole (e.g.: C. glabrata and C. krusei). A number of antifungal agents are approved for pediatric use, and their limits and advantages are analyzed in this article, but only micafungin is authorized for use in neonatal patients. Further trials are required in order to assess whether additional drugs could have a similar indication for neonatal use. A big issue is the correct identification of the most effective dosing regimen, because the drug pharmacokinetics is peculiar and somewhat unpredictable in newborn patients. In addition to fluconazole prophylaxis, other measures could be taken to prevent fungal infections in at-risk neonates, such as increasing hygienic measures, encouraging breast-feeding, removing CVCs, using probiotics, and decreasing or avoiding the use of drugs promoting the development of systemic mycoses.