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

systematic review and meta-analysis

  • 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

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.

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Published
2022-04-25
How to Cite
COKRO, Fonny; YOLANDA, Lorensia; CAROLINE, Shelly. Fluconazole Effectiveness in Preventing Invasive Fungal Infection in Very Low Birth Weight Infants: Systematic Review and Meta-analysis. JURNAL ILMU KEFARMASIAN INDONESIA, [S.l.], v. 20, n. 1, p. 14-22, apr. 2022. ISSN 2614-6495. Available at: <http://jifi.farmasi.univpancasila.ac.id/index.php/jifi/article/view/1035>. Date accessed: 30 nov. 2022. doi: https://doi.org/10.35814/jifi.v20i1.1035.
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Articles