Abstract
The main indications for antifungal drug administration in pediatrics are reviewed as well as an update of the data of antifungal agents and antifungal policies performed. Specifically, antifungal therapy in three main areas is updated as follows: (a) Prophylaxis of premature neonates against invasive candidiasis; (b) management of candidemia and meningoencephalitis in neonates; and (c) prophylaxis, empiric therapy, and targeted antifungal therapy in children with primary or secondary immunodeficiencies. Fluconazole remains the most frequent antifungal prophylactic agent given to high-risk neonates and children. However, the emergence of fluconazole resistance, particularly in non-albicans Candida species, should be considered during preventive or empiric therapy. In very-low birth-weight neonates, although fluconazole is used as antifungal prophylaxis in neonatal intensive care units (NICU’s) with relatively high incidence of invasive candidiasis (IC), its role is under continuous debate. Amphotericin B, primarily in its liposomal formulation, remains the mainstay of therapy for treating neonatal and pediatric yeast and mold infections. Voriconazole is indicated for mold infections except for mucormycosis in children >2 years. Newer triazoles-such as posaconazole and isavuconazole-as well as echinocandins, are either licensed or under study for first-line or salvage therapy, whereas combination therapy is kept for refractory cases.
Highlights
Invasive fungal infections (IFIs) are important causes of excessive morbidity and mortality in pediatrics
The most frequent antifungal agent prophylactically administered to high-risk pediatric patients is fluconazole, based on trials that have shown that patients with allogeneic hematopoietic stem cell transplantation (HSCT) receiving fluconazole presented a significant better long-term follow-up probably due to less severe gut graft-versus-host disease (GVHD) [18,19,20,21]
Empiric fever-driven antifungal therapy has been considered as standard of care in hemato-oncological patients at high risk for invasive fungal disease with neutropenia, who present with refractory or a new fever of at least four days, despite broad-spectrum antibacterial therapy [11]
Summary
Invasive fungal infections (IFIs) are important causes of excessive morbidity and mortality in pediatrics. Candida spp. and Aspergillus spp. are the most common fungi causing IFIs in neonates, infants, children, and adolescents. There are various factors that can increase the risk for developing an IFI in pediatrics. J. Fungi 2018, 4, 115 administration, and limited clinical data. Fungi 2018, 4, 115 administration, and limited clinical data The impact of these pediatric factors has been recognized as a major issue during development of pediatric guidelines of IFI management [2]. The main indications for antifungal drug administration in pediatrics will be reviewed as well as an update of the data of antifungal agents as well as antifungal policies will be performed. Prophylaxis of premature neonates against invasive candidiasis; management of candidemia and meningoencephalitis in neonates; and prophylaxis, empiric therapy, and targeted antifungal therapy in children with primary or secondary immunodeficiencies.
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