Advances in the Treatment of Mycoses in Pediatric Patients

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.

<p>An Overview of the Management of the Most Important Invasive Fungal Infections in Patients with Blood Malignancies</p>

“…66 Drugs such as voriconazole and LAMB are used to treat infections caused by Aspergillus species, also other new drugs such as anidulafungin and isavuconazole are considered to be used widespreadly but this requires further studies. 54,67,68 For example, the results of a recent study showed that prophylaxis with isavuconazole is not effective in preventing invasive Aspergillus infections, and further studies are needed to use this drug widely. 52 Furthermore, drug resistance is a critical issue in Aspergillus species.…”

Fluconazole Resistance in Isolates of Uncommon Pathogenic Yeast Species from the United Kingdom

“…Fluconazole (FLC), a triazole antifungal with fungistatic activity against many Candida species, is one of the most frequently prescribed antifungal drugs (17). It is widely employed prophylactically in high-risk patients and especially in neonates (3,18), is the preferred treatment for Candida osteomyelitis and infections of the eyes and urinary tract (3), and is an appropriate step-down therapy for candidemia, disseminated hepatosplenic candidiasis, and central nervous system and intravascular infections in patients infected with isolates that are unlikely to be fluconazole resistant or are without prior fluconazole exposure (3). CBPs have been developed for fluconazole with several common Candida species (19), and ECVs have been proposed for some less common species (20).…”

Special Issue: Treatments for Fungal Infections

“…The importance of initiating antimycotic therapy against invasive fungal infections as early as possible is repeatedly stressed in the reviews of this Special Issue [1,4,7,10,11]. Consequently, considering the time required for isolation, identification and susceptibility testing, the initial therapy is often empiric.…”

“…Children/neonates present special challenges, such as the difficulty or impossibility of obtaining information directly from the patient and the need to adapt therapeutic protocols to the anatomy and physiology of this population [11]. Antifungal treatment in pediatric patients often involves prophylaxis in at-risk populations, such as neonates and immunosuppressed patients, or therapeutic intervention for treatment of active mycoses.…”

“…Antifungal treatment in pediatric patients often involves prophylaxis in at-risk populations, such as neonates and immunosuppressed patients, or therapeutic intervention for treatment of active mycoses. Special pediatric protocols for antifungal therapy have been devised [11].…”