Clinical pharmacology of antifungal agents in pediatrics: children are not small adults

• There is increasing knowledge of the PK of antifungal agents in children.
• Many widely used antifungal regimens lack a solid evidence base in children.
• Population PK studies are required for the polyenes and triazoles.
• The PK of the echinocandins is relatively well characterized.

The optimal dosage information to improve the prognosis of invasive fungal infections in children and neonates is still limited and current dosing strategies are supported mainly by adult studies and extrapolation. Significant progress has been made to address this need in the last decade. Pre-clinical models and pharmacokinetic-pharmacodynamic (PK-PD) bridging studies supported by pediatric pharmacokinetic studies have investigated optimal dosing regimens for neonates and children. Here, we review the rationale for various antifungal regimens in infants and children.