PDF(Pubmed)
Abstract：
UNASSIGNED: Invasive fungal infections (IFIs) are important infectious complications amongst critically ill children. The most common fungal infections are due to Candida species. Aspergillus, Zygomycetes and Fusarium are also emerging because of the empirical use of antifungal drugs. This updated review discusses the epidemiology of IFIs as well as antifungal drugs, dosing and potential adverse effects in critically ill children.
UNASSIGNED: A PubMed search was conducted with Clinical Queries using the key terms \"antifungal\", \"children\", \"critical care\" AND \"paediatric intensive care unit\" OR \"PICU\". The search strategy included clinical trials, randomized controlled trials, meta-analyses, observational studies and reviews and was limited to the English literature in paediatrics.
UNASSIGNED: Candida and Aspergillus spp. are the most prevalent fungi in paediatric IFIs, causing invasive candidiasis infections (ICIs) and invasive aspergillosis infections (IAIs), respectively. These IFIs are associated with high morbidity, mortality and healthcare costs. Candida albicans is the principal Candida spp. associated with paediatric ICIs. The risks and epidemiology for IFIs vary if considering previously healthy children treated in the paediatric intensive care unit or children with leukaemia, malignancy or a severe haematological disease. The mortality rate for IAIs in children is 2.5-3.5-fold higher than for ICIs. Four major classes of antifungals for critically ill children are azoles, polyenes, antifungal antimetabolites and echinocandins.
UNASSIGNED: Antifungal agents are highly efficacious. For successful treatment outcomes, it is crucial to determine the optimal dosage, monitor pharmacokinetics parameters and adverse effects, and individualized therapeutic monitoring. Despite potent antifungal medications, ICIs and IAIs continue to be serious infections with high mortality rates. Pre-emptive therapy has been used for IAIs. Most guidelines recommend voriconazole as initial therapy of invasive aspergillosis in most patients, with consideration of combination therapy with voriconazole plus an echinocandin in selected patients with severe disease. The challenge is to identify critically ill patients at high risks of ICIs for targeted prophylaxis. Intravenous/per os fluconazole is first-line pre-emptive treatment for Candida spp. whereas intravenous micafungin or intravenous liposomal amphotericin B is alternative pre-emptive treatment.This article is part of the Challenges and strategies in the management of invasive fungal infections Special Issue: https://www.drugsincontext.com/special_issues/challenges-and-strategies-in-the-management-of-invasive-fungal-infections.
UNASSIGNED: A PubMed search was conducted with Clinical Queries using the key terms \"antifungal\", \"children\", \"critical care\" AND \"paediatric intensive care unit\" OR \"PICU\". The search strategy included clinical trials, randomized controlled trials, meta-analyses, observational studies and reviews and was limited to the English literature in paediatrics.
UNASSIGNED: Candida and Aspergillus spp. are the most prevalent fungi in paediatric IFIs, causing invasive candidiasis infections (ICIs) and invasive aspergillosis infections (IAIs), respectively. These IFIs are associated with high morbidity, mortality and healthcare costs. Candida albicans is the principal Candida spp. associated with paediatric ICIs. The risks and epidemiology for IFIs vary if considering previously healthy children treated in the paediatric intensive care unit or children with leukaemia, malignancy or a severe haematological disease. The mortality rate for IAIs in children is 2.5-3.5-fold higher than for ICIs. Four major classes of antifungals for critically ill children are azoles, polyenes, antifungal antimetabolites and echinocandins.
UNASSIGNED: Antifungal agents are highly efficacious. For successful treatment outcomes, it is crucial to determine the optimal dosage, monitor pharmacokinetics parameters and adverse effects, and individualized therapeutic monitoring. Despite potent antifungal medications, ICIs and IAIs continue to be serious infections with high mortality rates. Pre-emptive therapy has been used for IAIs. Most guidelines recommend voriconazole as initial therapy of invasive aspergillosis in most patients, with consideration of combination therapy with voriconazole plus an echinocandin in selected patients with severe disease. The challenge is to identify critically ill patients at high risks of ICIs for targeted prophylaxis. Intravenous/per os fluconazole is first-line pre-emptive treatment for Candida spp. whereas intravenous micafungin or intravenous liposomal amphotericin B is alternative pre-emptive treatment.This article is part of the Challenges and strategies in the management of invasive fungal infections Special Issue: https://www.drugsincontext.com/special_issues/challenges-and-strategies-in-the-management-of-invasive-fungal-infections.
摘要：
侵袭性真菌感染(IFIs)是危重患儿的重要感染性并发症。最常见的真菌感染是由于念珠菌属物种。曲霉菌,由于抗真菌药物的经验性使用，孢子菌和镰刀菌也正在出现。这篇更新的综述讨论了IFIs和抗真菌药物的流行病学，危重患儿的剂量和潜在的不良反应。
■使用关键术语“抗真菌药”对临床查询进行了PubMed搜索，\"children\",\"重症监护\"和\"儿科重症监护病房\"或\"PICU\"。搜索策略包括临床试验，随机对照试验，荟萃分析，观察性研究和评论，仅限于儿科英语文献。
■念珠菌和曲霉属。是儿科IFIs中最常见的真菌，引起侵袭性念珠菌感染（ICIs）和侵袭性曲霉病感染（IAIs），分别。这些IFIs与高发病率相关，死亡率和医疗费用。白色念珠菌是主要的念珠菌属。与儿科ICIs相关。如果考虑以前在儿科重症监护病房接受治疗的健康儿童或患有白血病的儿童，国际金融机构的风险和流行病学会有所不同。恶性肿瘤或严重的血液疾病。儿童IAI的死亡率比ICI高2.5-3.5倍。危重儿童的四大类抗真菌药物是唑类，多烯，抗真菌抗代谢物和棘白菌素。
■抗真菌剂非常有效。对于成功的治疗结果，确定最佳剂量至关重要，监测药代动力学参数和不良反应，和个性化的治疗监测。尽管有有效的抗真菌药物,ICIs和IAIs仍然是严重的感染，死亡率很高。先发制人疗法已用于IAIs。大多数指南推荐伏立康唑作为大多数患者的侵袭性曲霉病的初始治疗。考虑在某些严重疾病患者中使用伏立康唑加棘白菌素的联合治疗。面临的挑战是识别具有ICI高风险的危重患者以进行针对性预防。静脉/口服氟康唑是念珠菌属的一线抢先治疗。而静脉注射米卡芬净或静脉注射脂质体两性霉素B是替代的抢先治疗.本文是侵袭性真菌感染管理中的挑战和策略的一部分特刊：https://www.drugsincontext.com/special_issues/challenge-and-strategies-in-the-the-management-of-侵袭性真菌感染.
■使用关键术语“抗真菌药”对临床查询进行了PubMed搜索，\"children\",\"重症监护\"和\"儿科重症监护病房\"或\"PICU\"。搜索策略包括临床试验，随机对照试验，荟萃分析，观察性研究和评论，仅限于儿科英语文献。
■念珠菌和曲霉属。是儿科IFIs中最常见的真菌，引起侵袭性念珠菌感染（ICIs）和侵袭性曲霉病感染（IAIs），分别。这些IFIs与高发病率相关，死亡率和医疗费用。白色念珠菌是主要的念珠菌属。与儿科ICIs相关。如果考虑以前在儿科重症监护病房接受治疗的健康儿童或患有白血病的儿童，国际金融机构的风险和流行病学会有所不同。恶性肿瘤或严重的血液疾病。儿童IAI的死亡率比ICI高2.5-3.5倍。危重儿童的四大类抗真菌药物是唑类，多烯，抗真菌抗代谢物和棘白菌素。
■抗真菌剂非常有效。对于成功的治疗结果，确定最佳剂量至关重要，监测药代动力学参数和不良反应，和个性化的治疗监测。尽管有有效的抗真菌药物,ICIs和IAIs仍然是严重的感染，死亡率很高。先发制人疗法已用于IAIs。大多数指南推荐伏立康唑作为大多数患者的侵袭性曲霉病的初始治疗。考虑在某些严重疾病患者中使用伏立康唑加棘白菌素的联合治疗。面临的挑战是识别具有ICI高风险的危重患者以进行针对性预防。静脉/口服氟康唑是念珠菌属的一线抢先治疗。而静脉注射米卡芬净或静脉注射脂质体两性霉素B是替代的抢先治疗.本文是侵袭性真菌感染管理中的挑战和策略的一部分特刊：https://www.drugsincontext.com/special_issues/challenge-and-strategies-in-the-the-management-of-侵袭性真菌感染.
