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Advances in the Treatment of Mycoses in Pediatric Patients
Elias Iosifidis1, Savvas Papachristou2, Emmanuel Roilides3
1Infectious Diseases Unit, 3rd Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Konstantinoupoleos 49, 54642, Thessaloniki, Greece. iosifidish@gmail.com.
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.
Insights
This review updates antifungal drug use in children, focusing on neonates and immunocompromised children. Fluconazole resistance is a growing concern, while Amphotericin B remains key for serious infections.
Area of Science:
- Pediatric Infectious Diseases
- Mycology
- Pharmacology
Background:
- Antifungal drug administration in pediatric populations requires careful consideration due to unique physiological and immunological factors.
- Invasive fungal infections pose significant risks, particularly in vulnerable groups like premature neonates and immunocompromised children.
- Evolving resistance patterns necessitate updated therapeutic strategies and policies.
Purpose of the Study:
- To review current indications for antifungal drug administration in pediatric patients.
- To provide an update on available antifungal agents and established antifungal policies.
- To specifically address antifungal strategies in neonates (prophylaxis, candidemia, meningoencephalitis) and children with immunodeficiencies.
Main Methods:
- Literature review and synthesis of current data on pediatric antifungal therapy.
- Analysis of antifungal prophylaxis and treatment guidelines for specific pediatric populations.
- Evaluation of the role of various antifungal agents, including fluconazole, amphotericin B, voriconazole, newer triazoles, and echinocandins.
Main Results:
- Fluconazole is frequently used for prophylaxis in high-risk neonates and children, but resistance in non-albicans Candida species is increasing.
- The role of fluconazole prophylaxis in very-low birth-weight neonates remains debated despite its use in neonatal intensive care units (NICUs).
- Liposomal amphotericin B is a primary treatment for neonatal and pediatric yeast and mold infections; voriconazole is indicated for specific mold infections in children over two years old.
Conclusions:
- Antifungal prophylaxis and treatment strategies in pediatrics must adapt to emerging resistance, particularly to fluconazole.
- Amphotericin B formulations are crucial for severe fungal infections in neonates and children.
- Newer antifungal agents and combination therapies offer potential for managing refractory cases and addressing resistance challenges.
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