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Administration and Dosing of Systemic Antifungal Agents in Pediatric Patients

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Abstract

Neonates and immunosuppressed/immunocompromised pediatric patients are at high risk of invasive fungal diseases. Appropriate antifungal selection and optimized dosing are imperative to the successful prevention and treatment of these life-threatening infections. Conventional amphotericin B was the mainstay of antifungal therapy for many decades, but dose-limiting nephrotoxicity and infusion-related adverse events impeded its use. Despite the development of several new antifungal classes and agents in the past 20 years, and their now routine use in at-risk pediatric populations, data to guide the optimal dosing of antifungals in children are limited. This paper reviews the spectra of activity for approved antifungal agents and summarizes the current literature specific to pediatric patients regarding pharmacokinetic/pharmacodynamic data, dosing, and therapeutic drug monitoring.

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Authors and Affiliations

  1. Division of Infectious Diseases, Children’s Hospital of Philadelphia, 2716 South Street, Suite 10360, Philadelphia, PA, 19146, USA

    Kevin J. Downes & Brian T. Fisher

  2. Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Kevin J. Downes & Brian T. Fisher

  3. Center for Clinical Pharmacology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Kevin J. Downes & Nicole R. Zane

  4. Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA

    Kevin J. Downes & Brian T. Fisher

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  1. Kevin J. Downes
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Correspondence to Kevin J. Downes.

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No sources of funding were used to conduct this study or prepare this manuscript.

Conflict of interest

KJD is supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under award number K23HD091365 and has received research support from Merck & Co., Inc. and Pfizer, Inc. unrelated to the current work. BTF has received research support from Pfizer, Inc. and Merck Pharmaceuticals unrelated to the current work. BTF also serves as the Chair of a data safety monitoring board for Astellas. NRZ is supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under award number 1K99HD096123. The content is solely the responsibility of the authors and does not necessarily represent the official views of any of the above supporting agencies.

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Downes, K.J., Fisher, B.T. & Zane, N.R. Administration and Dosing of Systemic Antifungal Agents in Pediatric Patients. Pediatr Drugs 22, 165–188 (2020). https://doi.org/10.1007/s40272-020-00379-2

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