ANTIFUNGAL PROPHYLAXIS STRATEGIES
George R Thompson, III, MD: Given these at-risk populations, how do you approach balancing prophylaxis with antifungal stewardship? Which patients do you consider for prophylaxis? It’s helpful to think about how we proceed from prophylaxis to empiric to targeted therapy in these patients (See Figure 2).
Figure 2. Timing of treatment for fungal infections.1
Antonio Arrieta, MD: The topic is very much in flux at this time. I think the increasing incidence of mold infections has resulted in oncology services being very anxious about the risk for infection. And there is an emphasis to try to put everybody on prophylaxis, with the idea that it’s always better to prevent than to have to treat, often with invasive surgical procedures, etc. But we have to try to better understand the incidence rate of each fungal infection for each type of malignancy so we can better manage prophylaxis and minimize the toxicities associated with these agents. There are studies coming out from the Children’s Oncology Group suggesting the benefits of prophylaxis not only with antifungals but also with antibiotics. But I think, at this stage, it is very common practice to put patients on prophylaxis with certain new diagnosis, such as AML, very high-risk ALL, relapsed ALL, those scheduled to receive HSCT, or scheduled for transplant.5,19,20
TABLE OF CONTENTS
- INTRODUCTION
- INVASIVE MOLD INFECTIONS: ON THE RISE IN CHILDREN (including risk factors)
- SPECIES DISTRIBUTION
- ANTIFUNGAL PROPHYLAXIS STRATEGIES
- CLINICAL PRESENTATION AND DIAGNOSIS OF INVASIVE MOLD DISEASE IN CHILDREN
- EMPIRIC THERAPY
- TARGETED TREATMENT (including isavuconazole for invasive mold infections)
- PHARMACOLOGY OF ANTIFUNGALS USED IN CHILDREN
- OVERALL MANAGEMENT OF ASPERGILLOSIS AND MUCORMYCOSIS
- DOSING AND ADMINISTRATION OF ANTIFUNGALS USED IN CHILDREN (including voriconazole, posaconazole, and isavuconazole)
- CAREGIVER AND PATIENT EDUCATION (including overall education, reducing the risk of infection at home, and setting expectations for therapy)
- REFERENCES
Faculty
George R. Thompson, III, MD
Professor of Medicine
University of California, Davis, School of Medicine
Sacramento, California
Antonio C. Arrieta, MD
Division Chief
Pediatric Infectious Diseases
Children’s Hospital of Orange County (CHOC)
Orange, California
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