Antifungal prophylaxis in pediatric patients undergoing therapy for cancer: drugs and dosing.

Invasive fungal disease (IFD) is an important cause of morbidity and mortality in immunocompromised patients. In contrast to adults, detailed information of pharmacokinetics and pharmacodynamics of many antifungal compounds is lacking in pediatric patients, and antifungal agents that have been proven to be effective in adults have not been licensed for children. We therefore review the current literature on drugs and dosing for antifungal prophylaxis in the pediatric age group.Although there are only few compounds approved for antifungal prophylaxis in children, an increasing number of reports describe safety and suggest efficacy of agents given to prevent IFD in the pediatric population. Owing to the small number of children included in most studies, however, evidence for efficacy has to be extrapolated from studies in adults. In addition, most studies do not address the optimal dosage of a compound to prevent IFD (optimal balance between efficacy and toxicity).Although there is a wide use of prophylactic antifungal agents in children, future studies need to establish the optimal dosing of each compound.