Antifungal Prophylaxis Summary of Recommendations in PICU (263) | Right Decisions

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Antifungal Prophylaxis Summary of Recommendations in PICU (263)

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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:

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)

Last reviewed: 24/05/2022

Next review date: 24/05/2025

Author(s): A Turner.

Version: 4

Approved By: PERG

Document Id: 263