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Antifungal-Induced Nephrotoxicity in Pediatrics: A State of the Art

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Combating Fungal Infections

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Abstract

Fungal infections are common in children with defects in host defences and in preterm newborns are responsible for considerable morbility and mortality. Thus antifungins are important in the treatment of fungal infections, particularly in at risk babies. Therefore, antifungins may be responsible for important side effects such as nephrotoxicity. In particular, the nephrotoxicity is an important adverse effect of amphotericin B, which is higher in preterm babies than at-term neonates and infants. Therefore, Amphotericin B lipid formulations (AmBisome, AMLC, ABCD) showed less nephrotoxicity than Amphotericin B, in preterm babies, newborns and immunocompromized babies. Alternative antifungins (azoles, fluorinated pyrimidines and echinocardins) are currently available in children and newborns. Fluconazole is the most widely used and relatively well-tolerated azole. Unfortunately, clinical experience of treating children with the newer azoles (i.e., Variconazole) is more limited in newborns and children. Moreover, the treatment with Caspofungin (Echinocandin) could be considered a potential alternative to conventional antifungal therapy (Amphotericin B lipid formulations). Finally, other echinocandins are available but relatively few studies report safety data in newborns and children.

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Authors and Affiliations

  1. Neonatal Intensive Care Unit, Department of Pediatrics and Clinical Medicine, University of Cagliari, Cagliari, Italy

    Vassilios Fanos

  2. Department of Mother and Child, Biology-Genetics, Section of Paediatrics, University of Verona, Verona, Italy

    Marco Zaffanello

  3. Department of Public Health & Community Medicine-Section of Pharmacology, University of Verona, Verona, Italy

    Laura Cuzzolin

  4. Neonatology Division, Sacred Hearth Catholic University of Rome, Policlinico Gemelli, Rome, Italy

    Luigi Cataldi

Authors
  1. Vassilios Fanos
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  2. Marco Zaffanello
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  3. Laura Cuzzolin
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  4. Luigi Cataldi
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Corresponding author

Correspondence to Vassilios Fanos .

Editor information

Editors and Affiliations

  1. Fac. Agricultural Sciences, Dept. Agricultural Microbiology, Aligarh Muslim University, Aligarh, 202002, India

    Iqbal Ahmad

  2. Dept. Biochemistry, Interdiciplinary Biotechnology Unit, Aligarh Muslim University, Aligarh, 202 002, India

    Mohammad Owais

  3. J. N. Medical College, Dept. Microbiology, Aligarh Muslim University, Aligarh, 202002, India

    Mohammed Shahid

  4. James Graham Brown Cancer Center, S. Preston Street 580, Louisville, 40202, USA

    Farrukh Aqil

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Fanos, V., Zaffanello, M., Cuzzolin, L., Cataldi, L. (2010). Antifungal-Induced Nephrotoxicity in Pediatrics: A State of the Art. In: Ahmad, I., Owais, M., Shahid, M., Aqil, F. (eds) Combating Fungal Infections. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-12173-9_6

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