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Population Pharmacokinetic Study of Prophylactic Fluconazole in Preterm Infants for Prevention of Invasive Candidiasis. Antimicrob Agents Chemother 2019; 63:AAC.01960-18. [PMID: 30910892 DOI: 10.1128/aac.01960-18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 03/14/2019] [Indexed: 12/18/2022] Open
Abstract
Fluconazole is an antifungal agent with reported evidence for its prophylactic effect against systemic fungal infection in preterm infants. The aim of this study was to build a population pharmacokinetic model to evaluate the pharmacokinetic characteristics of intravenous and oral fluconazole in preterm infants with the current prophylactic fluconazole dosing regimen. A pharmacokinetic model was developed using 301 fluconazole concentrations from 75 preterm infants with a baseline body weight (WT) ranging from 0.5 to 1.5 kg and an estimated glomerular filtration rate (eGFR) ranging from 12.9 to 58.5 ml/min/1.73 m2 Eligible infants received an intravenous or oral dose of 3 mg/kg of body weight of fluconazole, twice weekly with a ≥72-h dose interval, for 4 weeks. The model was qualified with basic goodness-of-fit diagnostics, visual predictive checks, and bootstrapping. The fluconazole pharmacokinetics was well described with a one-compartment linear model with a proportional residual error. The population clearance (CL) and volume of distribution (V) were derived as 0.0197 × (WT/1.00)0.746 × (eGFR/25.0)0.463 × exp(η) and 1.04 × WT × exp(η), respectively. Such covariate analyses augment the awareness of the need for personalized dosing in preterm infants. (This study has been registered at ClinicalTrials.gov under identifier NCT01683760).
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Lee J, Kim HS, Shin SH, Choi CW, Kim EK, Choi EH, Kim BI, Choi JH. Efficacy and safety of fluconazole prophylaxis in extremely low birth weight infants: multicenter pre-post cohort study. BMC Pediatr 2016; 16:67. [PMID: 27184665 PMCID: PMC4869366 DOI: 10.1186/s12887-016-0605-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 05/11/2016] [Indexed: 12/02/2022] Open
Abstract
Background There have been many studies supporting fluconazole prophylaxis in preterm infants for prevention of invasive fungal infections (IFIs). However, the routine use of fluconazole prophylaxis in neonatal intensive care units (NICUs) raises concerns with respect to resistance development, including the selection of resistant Candida species. We aimed to evaluate the efficacy and safety of fluconazole prophylaxis in extremely low birth weight (ELBW) infants. Methods An interventional pre-post cohort study at two tertiary NICUs was conducted. Data from two 5-year periods with and without fluconazole prophylaxis (Mar 2008–Feb 2013 and Mar 2003–Feb 2008) was compared. Prophylactic fluconazole was administered starting on the 3rd day at a dose of 3 mg/kg twice a week for 4 weeks during the prophylaxis period. Results The fluconazole prophylaxis group consisted of 264 infants, and the non-prophylaxis group consisted of 159 infants. IFI occurred in a total of 19 neonates (4.7 %) during the 10-year study period. Fluconazole prophylaxis lower the fungal colonization rate significantly (59.1 % vs. 33.9 %, P <0.001). However, the incidence of IFIs in ELBW infants was not reduced after fluconazole prophylaxis (4.4 % vs. 5.5 %, P = 0.80). Rather, although the increase did not reach statistical significance, fluconazole prophylaxis tended to increase the incidence of invasive infections involving fluconazole-resistant C. parapsilosis (0 % vs. 41.7 %, P = 0.11). Conclusions Fluconazole prophylaxis was not efficacious in decreasing IFIs in ELBW infants. There is a need for targeting prophylaxis to greatest risk population and prospective studies to measure the long-term effect of fluconazole prophylaxis on the emergence of organisms with antifungal resistance. Electronic supplementary material The online version of this article (doi:10.1186/s12887-016-0605-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Juyoung Lee
- Department of Pediatrics, Inha University School of Medicine, 100 Inharo, Incheon, Nam-gu, 22212, Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University Children`s Hospital, 101 Daehak-ro, Seoul, Jongno-gu, 03080, Korea. .,Department of Pediatrics, Seoul National University College of Medicine, 103 Daehak-ro, Seoul, Jongno-gu, 03080, Korea.
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University Children`s Hospital, 101 Daehak-ro, Seoul, Jongno-gu, 03080, Korea
| | - Chang Won Choi
- Department of Pediatrics, Seoul National University College of Medicine, 103 Daehak-ro, Seoul, Jongno-gu, 03080, Korea.,Department of Pediatrics, Seoul National University Bundang Hospital, 82, Gumi-ro 173, Bundang-gu, Seongnam, Gyeonggi, 13620, Korea
| | - Ee-Kyung Kim
- Department of Pediatrics, Seoul National University Children`s Hospital, 101 Daehak-ro, Seoul, Jongno-gu, 03080, Korea
| | - Eun Hwa Choi
- Department of Pediatrics, Seoul National University Children`s Hospital, 101 Daehak-ro, Seoul, Jongno-gu, 03080, Korea.,Department of Pediatrics, Seoul National University College of Medicine, 103 Daehak-ro, Seoul, Jongno-gu, 03080, Korea
| | - Beyong Il Kim
- Department of Pediatrics, Seoul National University College of Medicine, 103 Daehak-ro, Seoul, Jongno-gu, 03080, Korea.,Department of Pediatrics, Seoul National University Bundang Hospital, 82, Gumi-ro 173, Bundang-gu, Seongnam, Gyeonggi, 13620, Korea
| | - Jung-Hwan Choi
- Department of Pediatrics, Seoul National University Children`s Hospital, 101 Daehak-ro, Seoul, Jongno-gu, 03080, Korea.,Department of Pediatrics, Seoul National University College of Medicine, 103 Daehak-ro, Seoul, Jongno-gu, 03080, Korea
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