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Antibacterials 

Antibacterials
Chapter:
Antibacterials
DOI:
10.1093/med/9780198729228.003.0001
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date: 19 November 2019

Invasive fungal infections are an important cause of morbidity and mortality in immunocompromised children. Effective management includes prompt recognition, early administration of appropriate antifungal agents, reversal of immunosuppression, and, at times, surgical debridement. Our options for medical treatment of fungal infections have significantly increased over the last decades. Newer agents with improved safety profile or increased activity have been introduced, including lipid formulations of amphotericin B, the second-generation triazoles, voriconazole and posaconazole, and the echinocandins, caspofungin, micafungin, anidulafungin. These agents were primarily studied in adults. However, their pharmacology often differs considerably between children and adults, a fact that may have significant implications for optimal dosing in the paediatric population. Indeed, data on pharmacokinetics, safety, and efficacy in infants and older children are gradually accumulating over the last years. For some of these drugs, such as voriconazole, caspofungin, and micafungin, our understanding of pharmacokinetics and efficacy in the paediatric population has led to revised recommendations on dosing and indications for use; for others, such as posaconazole and anidulafungin, firm recommendations cannot yet be made. Therefore, paediatric clinical studies are still needed for some of these agents in order to allow, or optimize, their use across all age ranges, from infancy to adolescence.

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