An Overview of Advances in the Treatment of Mycoses in Pediatric Patients

Invasive fungal infections (IFIs) are important causes of excessive morbidity and mortality in
pediatrics. There are various factors that can increase the risk for developing an IFI in pediatrics. 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.