Systematic review and meta-analysis of four randomised controlled trials suggest that prophylactic fluconazole reduces the incidence of invasive fungal infection in very low birthweight infants. Further trials are needed to provide more precise estimates of effect size, and to assess the effect on mortality, neurodevelopment and the emergence of antifungal resistance.
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Competing interests: WMcG has received research funds from Pfizer UK Ltd, a manufacturer of fluconazole. This company had no role in the collection, analysis and interpretation of data, or in the writing of the report or decision to submit for publication.