The main indications for antifungal drug administration in pediatrics are reviewed as well as an update of the data of
antifungal agents and antifungal policies performed. Specifically, antifungal
therapy in three main areas is updated as follows: a) Prophylaxis of premature neonates against
invasive candidiasis; b) management of
candidemia and
meningoencephalitis in neonates; and c) prophylaxis, empiric
therapy, and targeted antifungal
therapy in children with primary or secondary immunodeficiencies.
Fluconazole remains the most frequent antifungal prophylactic agent given to high-risk neonates and children. However, the emergence of
fluconazole resistance, particularly in non-albicans Candida species, should be considered during preventive or empiric
therapy. In very-low birth-weight neonates, although
fluconazole is used as antifungal prophylaxis in neonatal intensive care units (NICU's) with relatively high incidence of
invasive candidiasis (IC), its role is under continuous debate.
Amphotericin B, primarily in its liposomal formulation, remains the mainstay of
therapy for treating neonatal and pediatric yeast and mold
infections.
Voriconazole is indicated for mold
infections except for
mucormycosis in children >2 years. Newer
triazoles-such as
posaconazole and
isavuconazole-as well as
echinocandins, are either licensed or under study for first-line or
salvage therapy, whereas combination
therapy is kept for refractory cases.