Anti-fungal prophylaxis in PICU: summary of recommendations

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Objectives

This guideline provides recommendations for the assessment and institution of antifungals in the Paediatric Intensive Care Unit.

Scope

NOTE: This guideline does NOT apply to patients from Schiehallion Ward, patients with neutropenia or patients with primary immunodeficiencies. 

Multiple risk factors must be present to justify fluconazole anti-fungal prophylaxis.

Consider Antifungal Prophylaxis in the following situations:

Give Fluconazole:

  1. High risk diagnosis (NEC or perforated gut, burn, ECMO, low cardiac output state) and
  2. ≥ 3 antibiotics and
  3. PICU length of stay > 7 days and
  4. Central venous line or urinary catheter in situ and
  5. Candida isolated from ≥ 2 sites*

* If no surface swabs taken then No. 5 not necessary.

Give Nystatin:

  1. High risk diagnosis that does not fulfil criteria for fluconazole or
  2. All patients ≥ 2 antibiotics or
  3. Candida isolated from ≥ 2 sites

Fluconazole Prophylaxis:

Dose

6mg/kg (can increase to 12mg/kg if neutropenia

present)

Neonate < 2

Administer every 72 hours

Neonate 2-4

Administer every 48 hours

Child 1 month-18 years

Administer every 24 hours (max dose 400mg)

Route

Commence iv, if feeds tolerated switch to ng/oral

(90% bioavailability via ng/oral route)

Nystatin Prophylaxis:

Dose                            

200,000IU 4 x daily

Route

If able to swallow – oral

If not able to swallow – ng (1ml ng, 1ml into mouth)

Editorial Information

Last reviewed: 01 March 2018

Next review: 31 March 2021

Author(s): A Turner

Version: 1.1

Approved By: PERG