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Published on: February 14, 2018
Antifungal agents in neonates: issues and recommendations
Benito Almirante1, Dolors Rodríguez
1Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain. balmirante@vhebron.net
Paediatric Drugs
|October 12, 2007
Summary
Neonatal fungal infections require careful antifungal treatment. Pharmacokinetic data reveal potential dosing differences in neonates compared to adults for certain antifungal agents, necessitating further research for optimal use.
Area of Science:
- Neonatal pharmacology
- Infectious diseases
- Pediatric medicine
Background:
- Fungal infections cause significant mortality and morbidity in neonates, especially premature infants.
- Current antifungal treatment guidelines for pediatric patients often rely on adult data due to limited pediatric-specific research.
- Understanding antifungal pharmacokinetics in neonates is crucial for effective treatment and prophylaxis.
Purpose of the Study:
- To review existing data on fungal infections and antifungal agents in neonatal patients.
- To highlight differences in antifungal pharmacology between neonates and adults.
- To inform optimal antifungal dosing and usage in the neonatal population.
Main Methods:
- Systematic review of published literature on neonatal fungal infections and antifungal agents.
- Analysis of pharmacokinetic data for various antifungal classes in neonates versus adults.
- Evaluation of clinical data on the efficacy and safety of antifungals in neonatal populations.
Main Results:
- Pharmacokinetic data suggest potential dosing variations for some antifungals in neonates compared to adults, though not all agents are fully evaluated.
- Amphotericin B deoxycholate shows variable pharmacokinetics in neonates, but recommended doses are similar to adults.
- Fluconazole and newer amphotericin B formulations (liposomal, lipid complex) have supporting pharmacokinetic data for neonatal use, but optimal dosing remains challenging.
- Echinocandins like caspofungin require higher doses in children based on body surface area, while micafungin levels may be lower in smaller infants.
- Limited data exist for newer azoles (itraconazole, voriconazole, posaconazole) in neonates, and no data are available for ravuconazole and anidulafungin.
Conclusions:
- Pharmacological differences necessitate distinct dosing strategies for certain antifungal agents in neonates.
- Further research and pharmacokinetic studies are essential to establish optimal dosing and duration for newer antifungal agents in neonatal care.
- Current evidence supports the use of amphotericin B formulations and fluconazole, with ongoing evaluation for other agents to improve outcomes for neonatal fungal infections.
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