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Michael Cohen-Wolkowiez, Daniel K. Benjamin, Editorial Commentary: Fluconazole Therapeutic Drug Monitoring in Children With Cancer: Not Today, Clinical Infectious Diseases, Volume 59, Issue 11, 1 December 2014, Pages 1534–1536, https://doi.org/10.1093/cid/ciu661
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(See the Major Article by van der Elst et al on pages 1527–33.)
Fluconazole is an attractive first choice for invasive candidiasis in children because it demonstrates very good efficacy, has a favorable safety profile, provides an easy parenteral-to-enteral switch, and distributes extensively into body fluids and tissues, including the central nervous system [1]. This last feature is particularly important in children because the pathophysiology of invasive candidiasis in this population varies according to age and child development. In preterm infants, invasive candidiasis is often accompanied by Candida meningoencephalitis resulting in neurodevelopmental impairment, whereas in older children the disease behaves similarly as in adults. Fluconazole is also active against most Candida species affecting children in multiple settings, and the pharmacokinetic (PK) properties of the drug are favorable with linear kinetics, long half-life (approximately 24 hours), and easy administration. The primary surrogate PK/pharmacodynamic (PD) target for fluconazole is the area under the concentration–time curve (AUC) to minimum inhibitory concentration ratio, and AUCs of 400–800 mg × h/L are associated with favorable outcomes in adults [2].
