Anti-fungal prophylaxis in PICU: summary of recommendations

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:

Nystatin Prophylaxis: