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Administration and Dosing of Systemic Antifungal Agents in Pediatric Patients

Kevin J Downes1,2,3,4, Brian T Fisher5,6,7, Nicole R Zane8

  • 1Division of Infectious Diseases, Children's Hospital of Philadelphia, 2716 South Street, Suite 10360, Philadelphia, PA, 19146, USA. downeskj@email.chop.edu.

Paediatric Drugs
|January 25, 2020
PubMed

Insights

Pediatric invasive fungal diseases require careful antifungal selection and dosing. This review details current antifungal agents, focusing on pediatric pharmacokinetics, dosing, and therapeutic drug monitoring for better treatment outcomes.

Area of Science:

  • Pediatric Infectious Diseases
  • Mycology
  • Pharmacology

Background:

  • Neonates and immunocompromised children face high risks of invasive fungal diseases.
  • Conventional amphotericin B, while effective, has significant nephrotoxicity and infusion-related adverse events.
  • Limited pediatric-specific data exist for optimizing antifungal dosing despite new agent development.

Purpose of the Study:

  • To review the activity spectra of approved antifungal agents.
  • To summarize current literature on pediatric antifungal pharmacokinetics/pharmacodynamics.
  • To provide guidance on pediatric antifungal dosing and therapeutic drug monitoring.

Main Methods:

  • Literature review of approved antifungal agents.
  • Analysis of pharmacokinetic/pharmacodynamic data in pediatric populations.
  • Summary of current dosing recommendations and therapeutic drug monitoring practices.

Main Results:

  • Review covers spectra of activity for various antifungal classes.
  • Highlights limited but growing body of pediatric pharmacokinetic/pharmacodynamic data.
  • Identifies need for optimized dosing strategies and therapeutic drug monitoring in children.

Conclusions:

  • Optimized antifungal selection and dosing are critical for treating invasive fungal infections in pediatric patients.
  • Further research is needed to establish evidence-based dosing guidelines for antifungals in neonates and immunocompromised children.
  • Therapeutic drug monitoring can aid in optimizing antifungal therapy for pediatric patients.

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