What is the treatment for candidiasis (fungal infection) in pediatric patients?

From the Guidelines

For pediatric patients with candidiasis, the recommended treatment is fluconazole, 12 mg/kg intravenous or oral daily, as a first-line option, or AmB deoxycholate, 1 mg/kg daily, for neonates with disseminated candidiasis, as per the most recent guidelines 1. The choice of antifungal medication depends on the severity and location of the infection, as well as the patient's age and underlying medical conditions.

• For oral thrush (oropharyngeal candidiasis), fluconazole can be given at 6 mg/kg on the first day, followed by 3 mg/kg daily for 7-14 days 1.
• For diaper dermatitis (cutaneous candidiasis), topical antifungals like nystatin, clotrimazole, or miconazole cream applied 2-3 times daily until 2-3 days after resolution is effective.
• For invasive or systemic candidiasis, intravenous fluconazole (8-12 mg/kg/day) or amphotericin B (0.5-1 mg/kg/day) may be necessary under hospital supervision, with treatment duration depending on clinical response and underlying conditions 1. It is essential to address underlying factors that may have contributed to the development of candidiasis, such as antibiotic use or immunosuppression, and to investigate for underlying conditions like diabetes or immunodeficiency in recurrent cases 1. Preventive measures, including good hygiene, avoiding unnecessary antibiotics, and proper bottle/pacifier cleaning for infants, can help reduce the risk of candidiasis in pediatric patients.
• The removal of central venous catheters (CVCs) is strongly recommended in patients with candidemia, as it can help prevent further complications and improve treatment outcomes 1.
• Imaging studies, such as computed tomography (CT) or ultrasound, may be necessary to evaluate for metastatic complications, particularly in patients with persistently positive blood cultures 1.

From the FDA Drug Label

1. 2 Candidemia in Non-neutropenic Patients and Other Deep Tissue Candida Infections Voriconazole tablets are indicated in adults and pediatric patients (aged 12 to 14 years weighing greater than or equal to 50 kg and those aged 15 years and older regardless of body weight) for the treatment of candidemia in non-neutropenic patients and the following Candida infections: disseminated infections in skin and infections in abdomen, kidney, bladder wall, and wounds
2. 3 Esophageal Candidiasis Voriconazole tablets are indicated in adults and pediatric patients (aged 12 to 14 years weighing greater than or equal to 50 kg and those aged 15 years and older regardless of body weight) for the treatment of esophageal candidiasis (EC) in adults and pediatric patients aged 12 to 14 years weighing greater than or equal to 50 kg and those aged 15 years and older regardless of body weight

The treatment for candidiasis (fungal infection) in pediatric patients is Voriconazole tablets. The recommended dosing regimen is not explicitly stated in the label for pediatric patients, but it is indicated for the treatment of:

• Candidemia in non-neutropenic patients
• Other deep tissue Candida infections
• Esophageal Candidiasis in pediatric patients aged 12 to 14 years weighing greater than or equal to 50 kg and those aged 15 years and older regardless of body weight 2.

From the Research

Treatment Options for Candidiasis in Pediatric Patients

• Topical antifungal drugs such as nystatin and miconazole are commonly used to treat oral candidiasis in pediatric patients 3, 4.
• These drugs are effective but may require a long treatment duration to eradicate the infection 3.
• Systemic antifungal agents like fluconazole, itraconazole, and voriconazole can be used to treat oral candidiasis that does not respond to topical treatment 3, 5.
• Echinocandins, such as anidulafungin and caspofungin, can be used intravenously to treat systemic candidiasis 3, 5.
• In cases of candidemia, fluconazole or an echinocandin is recommended as empiric therapy, depending on disease severity and other characteristics 6.

Considerations for Treatment

• The choice of antifungal agent depends on the severity of the infection, the patient's age and health status, and the presence of any underlying medical conditions 4, 6.
• Non-absorbable antifungal agents like nystatin are preferred for treating neonatal oral candidiasis, while systemically active agents like fluconazole are used for more severe infections or when there is a risk of dissemination 4.
• The risk of drug-induced liver toxicity should be considered when using systemically active antifungal agents in premature infants with sub-optimal liver function 4.

Antifungal Resistance

• Resistance to antifungal agents is a concern, particularly with the use of azoles, which can lead to the development of resistant Candida species 7.
• The main mechanism of high-level fungal azole resistance is energy-dependent drug efflux, and biofilm formation can also contribute to antifungal resistance 7.
• Removal of dental biofilms or treatments to prevent biofilm development in combination with antifungal drugs may improve treatment outcomes 7.