Antifungal agents in non-neonatologic pediatrics

Authors

  • Elio Castagnola Responsabile UOC Malattie Infettive, Istituto Giannina Gaslini, Genova

DOI:

https://doi.org/10.7175/rhc.v4i1S.860

Keywords:

Fungal infections, Antifungal agents, Pharmacokinetics, MIC, Penetration, Interactions, Fungicidal, Fungistatic

Abstract

The spectrum of action of antifungal agents helps driving the choice of the treatment, basing on the activity against the fungus of interest. Pharmacokinetics should also be taken into account, considering the time-dependent and the concentration-dependent drugs. Triazoles belong to the first group, while amphotericin B and echinocandins belong to the second one. The effectiveness of time-dependent drugs hangs on the time spent above the Minimal Inhibitory Concentration (MIC), whereas that of concentration-dependent drugs is related to the peak of concentration achieved. The
tissue penetration is another important factor that should be taken into account while prescribing an antifungal agent. Interactions with other drugs, above all with those used to treat underlying pathologies, should also be considered. Fungicidal drugs are generally preferred to fungistatic agents, therefore echinocandins and amphotericin B are more prescribed than azoles. Combination therapies are not recommended.

References

Brüggemann RJ, Alffenaar JW, Blijlevens NM, et al. Clinical relevance of the pharmacokinetic interactions of azole antifungal drugs with other coadministered agents. Clin Infect Dis 2009; 48: 1441-58; http://dx.doi.org/10.1086/598327

Cohen-Wolkowiez M, Benjamin DK Jr, Piper L, et al. Safety and pharmacokinetics of multiple-dose anidulafungin in infants and neonates. Clin Pharmacol Ther 2011; 89: 702-7; http://dx.doi.org/10.1038/clpt.2011.26

Arrieta AC, Maddison P, Groll AH. Safety of micafungin in pediatric clinical trials. Pediatr Infect Dis J 2011; 30: e97-e102

Hope WW, Castagnola E, Groll AH, et al; ESCMID Fungal Infection Study Group. ESCMID* guideline for the diagnosis and management of Candida diseases 2012: prevention and management of invasive infections in neonates and children caused by Candida spp. Clin Microbiol Infect 2012; 18 Suppl 7: 38-52; http://dx.doi.org/10.1111/1469-0691.1204

Driscoll TA, Yu LC, Frangoul H, et al. Comparison of pharmacokinetics and safety of voriconazole intravenous-to-oral switch in immunocompromised children and healthy adults. Antimicrob Agents Chemother 2011; 55: 5770-9; http://dx.doi.org/10.1128/AAC.00531-11; http://dx.doi.org/10.1128/AAC.05010-11

Soler-Palacín P, Frick MA, Martín-Nalda A, et al. Voriconazole drug monitoring in the management of invasive fungal infection in immunocompromised children: a prospective study. J Antimicrob Chemother 2012; 67: 700-6; http://dx.doi.org/10.1093/jac/dkr517

Markantonis SL, Katelari A, Pappa E, et al. Voriconazole pharmacokinetics and photosensitivity in children with cystic fibrosis. J Cyst Fibros 2012; 11: 246-52; http://dx.doi.org/10.1016/j.jcf.2011.12.006

Bernhard S, Kernland Lang K, Ammann RA, et al. Voriconazole-induced phototoxicity in children. Pediatr Infect Dis J 2012; 31: 769-71; http://dx.doi.org/10.1097/INF.0b013e3182566311

Groll A, Castagnola E, Cesaro S, et al. ECIL 4 – Pediatric Group Considerations for Fungal Diseases and Antifungal Treatment in Children. Disponibile all’indirizzo http://www.ebmt.org/Contents/Resources/Library/ECIL/Documents/ECIL%204%202011%20Paediatric%20guidelines%20Fungi%20and%20antifungals.pdf (ultimo accesso gennaio 2013)

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Published

2013-07-11

Issue

Vol. 4 No. 1S (2013)

Section

Supplement

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