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Usage of Antifungal Agents in Pediatric Patients Versus Adults: Knowledge and Gaps
Maria Kourti1, Emmanuel Roilides2
1Infectious Diseases Unit, 3rd Department of Pediatrics, Aristotle University School of Medicine, and Hippokration Hospital, Thessaloniki, Greece.
Abstract:
Invasive fungal infections (IFIs) present significant challenges in managing hospitalized and immunocompromised pediatric patients, contributing to high morbidity and mortality. Despite advancements in diagnostics and treatment, outcomes remain suboptimal due to unique clinical epidemiology, lack of pediatric-specific trials, and varied pharmacokinetics. The emergence of new antifungal classes and agents has expanded our options for preventing and treating IFIs in children, enhancing the safety and effectiveness of antifungal therapy. The oral formulations of ibrexafungerp, fosmanogepix and olorofim along with the extended dosing intervals of rezafungin show promising features for effective antifungal treatment in pediatrics. Despite the promising potential of novel antifungal drugs, their performance in heavily immunosuppressed patients remains unstudied. Until then, dedicated antifungal stewardship programs for high-risk patients are essential to optimize therapeutic outcomes, improve patient care, and limit the emergence of resistance.
Insights
New antifungal drugs offer hope for treating invasive fungal infections (IFIs) in children, but their efficacy in immunocompromised pediatric patients requires further study. Antifungal stewardship programs are crucial for optimizing care and preventing resistance.
Area of Science:
- Pediatric Infectious Diseases
- Mycology
- Pharmacology
Background:
- Invasive fungal infections (IFIs) pose a significant threat to hospitalized and immunocompromised children, leading to high morbidity and mortality.
- Current treatment outcomes for pediatric IFIs are suboptimal due to unique epidemiological factors, limited pediatric-specific research, and variable drug pharmacokinetics.
Purpose of the Study:
- To review the emergence of novel antifungal agents and their potential application in pediatric invasive fungal infections.
- To highlight the challenges and future directions in managing IFIs in pediatric populations.
Main Methods:
- Review of recent advancements in antifungal drug development.
- Analysis of emerging antifungal agents with potential pediatric applications.
- Discussion of clinical considerations for antifungal stewardship in pediatric IFIs.
Main Results:
- Novel antifungal agents, including oral formulations of ibrexafungerp, fosmanogepix, and olorofim, alongside rezafungin with extended dosing, show promise for pediatric antifungal therapy.
- The safety and effectiveness of these new agents in heavily immunosuppressed pediatric patients are yet to be determined.
Conclusions:
- New antifungal drugs present promising therapeutic options for pediatric IFIs, improving safety and efficacy.
- Further research is needed to evaluate novel antifungals in vulnerable pediatric populations.
- Antifungal stewardship programs are essential for optimizing treatment outcomes and combating resistance in high-risk pediatric patients.
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