EMPIRIC THERAPY
George R Thompson, III, MD: What is the role of empiric therapy in pediatrics when you have symptoms suggestive of an invasive infection?
Antonio Arrieta, MD: We are quite aggressive, I would say. The problem comes when you have to decide if you’re dealing with Aspergillus spp. or you’re dealing with a different fungus. The empiric treatment of invasive fungal disease is complicated, and often we have to decide to use liposomal amphotericin B at higher doses than typically recommended for the treatment of Mucor that will also treat Aspergillus spp. Often, we have to consider using azole agents that have activity against some of the Mucorales, such as isavuconazole or posaconazole.26 But, we try to start empirically early while we continue to try to identify the fungus.
George R Thompson, III, MD: That speaks to sometimes the uncertainty of diagnosis. In those circumstances, we’ve often really wanted to use a non-voriconazole mold agent just to cover Mucorales as well.
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
MyCARE thanks Astellas for sponsoring this activity.
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