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. 2022 Jun;14(2):15-34.
doi: 10.1007/s40506-022-00258-z. Epub 2022 May 16.

Updates in the Pharmacologic Prophylaxis and Treatment of Invasive Candidiasis in the Pediatric and Neonatal Intensive Care Units: Updates in the Pharmacologic Prophylaxis

James Hunter Fly  1   2 , Seerat Kapoor  1   2 , Kelly Bobo  1   2 , Jeremy S Stultz  1   2
Affiliations

Updates in the Pharmacologic Prophylaxis and Treatment of Invasive Candidiasis in the Pediatric and Neonatal Intensive Care Units: Updates in the Pharmacologic Prophylaxis

James Hunter Fly et al. Curr Treat Options Infect Dis. 2022 Jun.

Abstract

Purpose of review: The goal of this review was to provide an update on the prevention and treatment options for invasive candidiasis (IC) in the neonatal intensive care unit (NICU) and pediatric intensive care unit (PICU).

Recent findings: Studies have further validated the use of fluconazole for IC prophylaxis among high-risk patients in the NICU. It remains unclear if prophylaxis leads to resistance development and the ideal dosage regimen is still not clear. Recent studies have been published comparing caspofungin and micafungin to amphotericin B and illustrated similar efficacy outcomes in the NICU. Micafungin now has approval from the United States Food and Drug Administration (FDA) for use in infants < 4 months of age. Prophylactic strategies in the PICU could include zinc and vitamin D. Anidulafungin has recent non-comparative data supporting use in pediatric patients older than 1 month of age and also has a recent FDA approval for use in children 1 month of age and older.

Summary: Fluconazole prophylaxis remains a reasonable strategy in select NICU patients, although further analyses of resistance and the optimal dosage regimen are needed. Echinocandins are potential therapeutic options for non-meningitis or urinary tract infections in both the neonatal and pediatric population.

Keywords: Amphotericin B; Antifungal; Candidiasis; Echinocandin; Fluconazole; Pediatric.

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Figures

Fig. 1
Fig. 1
Relevant antifungal US Food and Drug Administration approvals since 2004. Approvals may only be for certain locations of infection (e.g., candidemia, meningitis, urinary tract infections) (Historical Food and Drug Administration label histories available at: https://www.accessdata.fda.gov/scripts/cder/daf/).
See this image and copyright information in PMC

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