Child/Adolescent Health

The number of hospitalized children on antifungal therapy has increased along with use of newer antifungal agents

Factors such as cancer chemotherapy and medications used to suppress the body's rejection of transplanted organs or stem cells weaken children's immune systems, making them vulnerable to invasive fungal infections that can be fatal. The frequency and severity of invasive fungal infections in immunocompromised children has steadily grown over the last two decades. A new study shows a rise in the use of antifungal therapy for hospitalized children and a shift to new antifungal agents. Researchers at the University of Pennsylvania School of Medicine Center for Education and Research on Therapeutics (CERT) and colleagues used the Pediatric Health Information System database to describe the changes in pediatric antifungal therapy at 25 U.S. children's hospitals from 2000 to 2006.

Overall, 62,842 children received antifungal therapy (including 5,839 neonates), with prescriptions increasing significantly during the 7-year study period. Fluconazole was the most commonly prescribed antifungal agent (given to 76 percent of children), followed by amphotericin preparations (26 percent). Fluconazole was the most commonly prescribed agent in neonates (65 percent), followed by conventional amphotericin B or AMB (30 percent), and lipid formulations of amphotericin B or LFAB (20 percent).

Prescriptions of AMB, once considered the standard of treatment for invasive fungal infections but whose use was limited by its toxicity at high doses, steadily decreased from 2000 to 2006. AMB was replaced by LFAB and the newer agents, voriconazole (especially to treat aspergillosis) and echinocandins (especially to treat candidiasis). The authors call for more research to determine the optimal dosing, efficacy, and safety of these newer agents in children.

The study was supported in part by a grant from the Agency for Healthcare Research and Quality to the University of Pennsylvania School of Medicine CERT (HS10399). For more information on the CERTs program, visit http://certs.hhs.gov/.

See "Pediatric antifungal utilization: New drugs, new trends," by Priya A. Prasad, M.P.H., Susan E. Coffin, M.D., M.P.H., Kateri H. Leckerman, M.S., and others, in the December 2008 Pediatric Infectious Disease Journal 27(12), pp. 1083-1088.

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