Pharmacokinetics and Pharmacodynamics of Antifungal Agents in Neonates and Children

Abstract

This review summarizes current knowledge on pharmacokinetics (PK) and pharmacodynamics (PD) of various formulations of amphotericin B, triazoles (fluconazole, itraconazole, voriconazole, posaconazole, isavuconazole), and echinocandins (caspofungin, micafungin, anidulafungin) in the pediatric population. The PD indices associated with in vivo outcome have been defined for all antifungal agents. PK parameters have been studied across all range of ages; however, data often originate from small patient series, particularly regarding neonates and young infants. Dose-exposure simulations in population PK studies provide the probability of PD target attainment using various dosage regimens. Therapeutic drug monitoring (TDM) has been recognized as a valuable tool to individualize dosing for azoles due to significant inter-patient variability. Our understanding of PK/PD of antifungal agents in pediatric patients has significantly advanced over the last years allowing age-specific dosing recommendations. Yet, however, several PK questions regarding specific patient groups remain to be addressed.