ABSTRACT
INTRODUCTION In recent years, the antifungal landscape has been changing rapidly, with several newer agents approved and clinicians striving to determine the optimal niches for each new agent in the overall therapeutic armamentarium. Unfortunately, studies with these agents in pediatric patients are slow and often clinical development and investigation stop after only initial pharmacokinetic exploration. Even the limited data we have on pediatric antifungals points to interesting differences between both adult and pediatric pharmacokinetics for the same agent, as well as differences among pediatric pharmacokinetics within the individual drug classes. For example, voriconazole displays nonlinear pharmacokinetics in adults but linear pharmacokinetics in children, demanding higher doses in smaller patients and possibly explaining treatment failures due to underdosing using the approved adult dosing regimen. Likewise, caspofungin requires higher doses in pediatric compared to adults, and dosing is best accomplished by using a body surface area regimen rather than a body weight scheme. Micafungin displays a clear trend toward lower plasma drug levels obtained in neonatal patients, emphasizing the importance of the neonatal period as a separate age group among pediatric patients.
