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Objectives: We tested the hypothesis that twice weekly prophylactic dosing of fluconazole prevents invasive candidiasis without promoting resistant Candida sp ecies in high-risk, preterm infants. Study design: We compared our previous dos ing schedule (Group A) to a less frequent dosing schedule of twice a week (Group B) of fluconazole prophylaxis for up to 6 weeks in a prospective, randomized, d ouble-blind clinical trial in preterm infants weighing<1000 grams at birth and with an endotracheal tube and/or central vascular catheter over a 24-month peri od. Weekly surveillance cultures were obtained on study patients. Results: Candi da colonization was documented in 5 (12%) of 41 Group A and in 4 (10%) of 40 G roup B infants. Candida sepsis developed in two (5%) of Group A and one (3%) o f Group B infants (risk difference, -0.02; 95%confidence interval, -0.14-0.1 0; P = .68). All fungal isolates remained sensitive to fluconazole, and no drug side effects were documented. Conclusions: Twice weekly dosing of prophylactic f luconazole can decrease Candida colonization and invasive infection, cost, and p atient exposure in high-risk, preterm infants weighing < 1000 grams at birth. W e speculate that lower and less frequent dosing may delay or prevent the emergen ce of antifungal resistance.
Objectives: We tested the hypothesis that twice weekly prophylactic dosing of fluconazole prevents the presence of candidiasis without promoting resistant Candida sp ecies in high-risk, preterm infants. Study design: We were collating previous schedule ing (Group A) to a less frequent dosing schedule of twice a week (Group B) of fluconazole prophylaxis for up to 6 weeks in a prospective, randomized, double-blind clinical trial in preterm infants weighing <1000 grams at birth and with an endotracheal tube and / or central vascular catheter over Results: Candida da colonization was documented in 5 (12%) of 41 Group A and in 4 (10%) of 40 G roup B infants. Candida sepsis developed in (5%) of Group A and one (3%) of Group B infants (risk difference, -0.02; 95% confidence interval, -0.14-0.1 0; P = .68). All fungal isolates remained sensitive to fluconazole, and no drug side effects were documented. Conclusions: Tw ice weekly dosing of prophylactic f luconazole can decrease candida colonization and invasive infection, cost, and p atient exposure in high-risk, preterm infants weighing <1000 grams at birth. W e speculate that lower and less frequent dosing may delay or prevent the emergen ce of antifungal resistance.