Antifungal Prophylaxis Summary of Recommendations in PICU (263)
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:
- High risk diagnosis (NEC or perforated gut, burn, ECMO, low cardiac output state) and
- ≥ 3 antibiotics and
- PICU length of stay > 7 days and
- Central venous line or urinary catheter in situ and
- Candida isolated from ≥ 2 sites*
* If no surface swabs taken then No. 5 not necessary.
Give Nystatin:
- High risk diagnosis that does not fulfil criteria for fluconazole or
- All patients ≥ 2 antibiotics or
- 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) |