New agents for invasive mycoses in children.

Immunocompromised Host Section, Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland 20892, USA.
Current Opinion in Pediatrics (Impact Factor: 2.63). 03/2005; 17(1):78-87. DOI: 10.1097/01.mop.0000150630.83442.e1
Source: PubMed

ABSTRACT Invasive fungal infections are an important cause of morbidity and mortality in immunocompromised children of all ages. This review summarizes information on new antifungal agents, including current data on their clinical use in children, as well as alternative strategies such as antifungal combination and immunomodulation therapy.
Novel antifungal agents, such as the echinocandins and the second-generation triazoles, were recently introduced that exhibit promising efficacy against Candida spp., Aspergillus spp., and other opportunistic fungal pathogens. These compounds are generally well tolerated and show substantial efficacy as salvage treatment and equal or even superior efficacy compared with older azoles or amphotericin B as first-line or empiric therapy for fungal infections. Clinical studies of pharmacokinetics and efficacy of the new agents in the pediatric population are, however, limited.
The response rates observed with the recently introduced drugs, although superior in some cases compared with older antifungal agents, are still far from satisfactory. The development of new antifungal compounds as well as the use of alternative approaches of combination therapy and immunomodulation should be pursued through well-designed laboratory and clinical studies in pediatric patients.

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    ABSTRACT: 1 СанктПетербургская медицинская академия последипломного образования, С.-Петербург 2 СанктПетербургская государственная педиатрическая медицинская академия, С.-Петербург 3 НИИ скорой помощи им. Н.В. Склифосовского, Москва 4 Республиканская детская клиническая больница, Москва 5 Центр трансплантации костного мозга, С.-Петербург 6 НИИ онкологии им. акад. Н.Н. Петрова, С.-Петербург 7 Детская республиканская клиническая больница Минздрава республики Татарстан, Казань 8 Детская клиническая больница, Красноярск 9 Российский онкологический научный центр им. акад. Н.Н. Блохина РАМН, Москва В проспективное исследование было включено 19 детей (от 1 до 17 лет) с инва-зивным микозом, имеющих различные про-явления иммуносупрессии. Проведена оцен-ка клиникомикологической эффективности и безопасности каспофунгина и анализ пря-мых затрат на лечение инвазивных микозов. Установлено, что у детей всех возрастных групп каспофунгин является эффективным и безо-пасным противогрибковым лекарственным средством как для эмпирического, так и для направленного лечения инвазивного кандидоза и аспергиллеза. При анализе прямых затрат установлено, что наибольшие затраты при лече-нии инвазивных микозов приходятся на каспо-фунгин – от 86 до 93%. Ключевые слова: инвазивные микозы, дети, каспофунгин, лечение, прямые затраты.
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    ABSTRACT: Candida species bloodstream infections have been associated with high morbidity and mortality, especially in patients hospitalized in a pediatric intensive care unit (PICU). The incidence of such infections is rising because of malignancies, prolonged PICU stay, and the use of broad-spectrum antibiotics. Although Candida albicans remains the most frequently isolated species, non-albicans Candida species have shown an increased frequency. Treatment with fluconazole or an echinocandin should be considered in patients at high risk for candidemia or as initial treatment for non-neutropenic patients with candidemia, in addition to the removal of intravascular catheters. Treatment with a lipid formulation of amphotericin B or caspofungin is suggested for neutropenic patients. Early diagnosis, prompt therapy, and prevention are the cornerstones of controlling infection and improving outcome. Although there are some differences between children and adults with candidemia, especially in antifungal drug therapy and outcome, in general the incidence, risk factors, species variation, diagnostic methods, and management are similar. KeywordsChildren–PICU–Candidiasis– Candida species–Pediatrics–Diagnosis–Risk factors–Management–Outcome
    Current Fungal Infection Reports 5(1):49-55.
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    ABSTRACT: Fungal infections are a significant cause of morbidity and mortality in immunocompromised children. Since the beginning of the 21st century, many new antifungals including the echinocandins (i.e., caspofungin, micafungin, anidulafungin) and the newer generation triazoles (i.e., voriconazole and posaconazole) have received Food and Drug Administration approval. Unfortunately, despite making great strides in the adult arena, these agents are not currently approved in the pediatric population. However, pharmacokinetic data and clinical experiences with these agents in infants, children, and adolescents are mounting. As such, this review will discuss key concepts in pediatric pharmacology and clinical use of these newer antifungal agents.
    The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG. 07/2008; 13(3):124-40.