Published online April 2, 2007
PEDIATRICS Vol. 119 No. 4 April 2007, pp. 772-784 (doi:10.1542/peds.2006-2931)
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REVIEW ARTICLE

Antifungal Therapy in Children With Invasive Fungal Infections: A Systematic Review

Christopher C. Blyth, MBBSa,b, Pamela Palasanthiran, MBBS, FRACP, MDa,b and Tracey A. O'Brien, FRACP, MBChB, MHL, BScb,c

a Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, New South Wales, Australia
b School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia
c Centre for Children's Cancer and Blood Disorders, Sydney Children's Hospital, Randwick, New South Wales, Australia

Invasive fungal infections are associated with significant morbidity and mortality. Differences between children and adults are reported, yet few trials of antifungal agents have been performed in pediatric populations. We performed a systematic review of the literature to guide appropriate pediatric treatment recommendations. From available trials that compared antifungal agents in either prolonged febrile neutropenia or invasive candidal or Aspergillus infection, no clear difference in treatment efficacy was demonstrated, although few trials were adequately powered. Differing antifungal pharmacokinetics between children and adults were demonstrated, requiring dose modification. Significant differences in toxicity, particularly nephrotoxicity, were identified between classes of antifungal agents. Therapy needs to be guided by the pathogen or suspected pathogens, the degree of immunosuppression, comorbidities (particularly renal dysfunction), concurrent nephrotoxins, and the expected length of therapy.

Key Words: antifungal agents • pediatrics • mycoses • candidiasis • aspergillosis • neutropenia

Abbreviations: IFI—invasive fungal infection • CAB—conventional amphotericin B deoxycholate • ABLC—amphotericin B lipid complex • ABCD—amphotericin B colloidal dispersion • RCT—randomized, controlled trial

Accepted Dec 12, 2006.


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