Fighting the fungus

Invasive fungal infection, mostly with Candida species, is a significant problem in neonatal care. There have been several trials showing that fluconazole prophylaxis can greatly reduce deaths or serious illness from Candida species, but no work to date that directly compares administering fluconazole to other strategies such as gut decontamination with nystatin. Fluconazole is given intravenously initially, then enterally once feeding is tolerated. Nystatin can be wiped around the mouth and put in the stomach to decontaminate the gut, and it can be used topically on the skin. There is an obvious attraction to using nystatin as no intravenous access is needed and it can be integrated into mouth care procedures, but is it as effective as fluconazole? This is the question that Aydemir et al set out to answer in a large head-to-head randomised controlled trial with a placebo arm. The result was that both methods of prophylaxis were found to be much more effective than placebo, and there was no difference in effectiveness between nystatin and fluconazole in preventing breakthrough infection. So it makes …