Clinical practice update of antifungal prophylaxis in immunocompromised children

• Published in: Revista española de quimioterapia Vol. 32; no. 5; pp. 410 - 425
• Main Authors: Ramos, J T, Romero, C A, Belda, S, Candel, F J, Carazo Gallego, B, Fernández-Polo, A, Ferreras Antolín, L, Garrido Colino, C, Navarro, M L, Nef, O, Olbright, P, Rincón-López, E, Ruiz Contreras, J, Soler-Palacín, P
• Format: Journal Article
• Language: English
• Published: Spain Sociedad Española de Quimioterapia 01.10.2019
• Subjects: Antifungal Agents - therapeutic use; Candidiasis - prevention & control; Child; Drug Monitoring; Hematopoietic Stem Cell Transplantation - adverse effects; HIV Infections - complications; Humans; Immunocompromised Host; Immunologic Deficiency Syndromes - complications; Immunosuppression - adverse effects; Infant, Extremely Premature; Infant, Newborn; Intensive Care Units, Pediatric; Invasive Fungal Infections - prevention & control; Neoplasms - drug therapy; Pneumonia, Pneumocystis - prevention & control; Primary Prevention - methods; Review; Risk Factors; Secondary Prevention - methods; Transplant Recipients
• ISSN: 0214-3429; 1988-9518

Due to the rise in the number and types of immunosuppressed patients, invasive fungal infections (IFI) are an increasing and major cause of morbidity and mortality in immunocompromised adults and children. There is a broad group of pediatric patients at risk for IFI in whom primary and/or secondary antifungal prophylaxis (AFP) should be considered despite scant evidence. Pediatric groups at risk for IFI includes extremely premature infants in some settings, while in high-risk children with cancer receiving chemotherapy or undergoing haematopoietic stem cell transplantation (HCT), AFP against yeast and moulds is usually recommended. For solid organ transplanted, children, prophylaxis depends on the type of transplant and associated risk factors. In children with primary or acquired immunodeficiency such as HIV or long-term immunosuppressive treatment, AFP depends on the type of immunodeficiency and the degree of immunosuppression. Chronic granulomatous disease is associated with a particular high-risk of IFI and anti-mould prophylaxis is always indicated. In contrast, AFP is not generally recommended in children with long stay in intensive care units. The choice of AFP is limited by the approval of antifungal agents in different age groups and by their pharmacokinetics characteristics. This document aims to review current available information on AFP in children and to provide a comprehensive proposal for each type of patient.