Abstract
In Japan, only a few antifungal agents have been approved for children, but in actual clinical practice, various antifungal agents used in adults are administered to pediatric patients with invasive fungal infections (IFIs). However, the pediatric dosages of some antifungal agents are not indicated in the package inserts or mentioned in the Japanese Mycology Study Group 2007 Guidelines for Management of Deep-seated Mycoses. We conducted a nationwide survey to determine how antifungal agents are being used to treat pediatric patients with IFIs in Japan. We sent a questionnaire to 792 medical centers that train pediatricians and received 250 (31.6 %) responses. In the past 5 years, 65 (26.0 %) of 250 facilities reported treating a total of 232 cases of IFIs. The characteristics of pediatric patients with IFIs were almost the same as adult patients except that immunological diseases and neonatal diseases are common as underlying diseases. Antifungal agents used in adults were all used in children. However, the dosages of some antifungal agents deviated from the package insert or guideline recommendations. As for the reasons for selecting a particular antifungal agent, strong antifungal activity (including potency, broad spectrum, and clinical efficacy) was favored over safety. These results can be used to revise guidelines for the management of children with IFIs.
Highlights
Invasive fungal infections (IFIs) are a major cause of morbidity and mortality in immunocompromised patients [1,2,3]
The pediatric dosages of some antifungal agents are not indicated in their package inserts, and they are not mentioned in the Japanese Mycology Study Group 2007
A questionnaire with the following three questions was sent to medical centers that train pediatricians in September 2009: J Infect Chemother (2013) 19:946–950 (1-1) Have you treated pediatric patients with IFIs in the last 5 years? (1-2) If yes, which specific diseases? (2-1) Which antifungal agents do you use typically? (2-2) What is the usual dosage? (3) In general, what are the reasons for selecting a particular antifungal agent? Multiple answers were allowed from the following choices: (a) strong antifungal activity, (b) broad antifungal spectrum, (c) fungicidal activity, (d) no drug-resistant strains, (e) high clinical efficacy, (f) high clinical safety, (g) recommendation by a guideline, (h) abundant evidence, (j) indication in children, (k) considerable experience, (l) others
Summary
Invasive fungal infections (IFIs) are a major cause of morbidity and mortality in immunocompromised patients [1,2,3]. IFIs often occur in children with various reasons for increased susceptibility to infections, including immature immune systems [4, 5]. The incidence of IFIs in children has increased with expanded pediatric use of therapies such as intensive chemotherapy, hematopoietic stem cell transplantation, or both for leukemia, and immunotherapy with steroids or immunosuppressants [6]. Diagnosis of IFIs is challenging in children, because there are few characteristic symptoms in patients with severe underlying diseases, and because of the invasive nature of diagnostic examinations for IFIs [7]. We thought it was necessary to determine the actual status of antifungal agent usage in children
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