Invasive mold infections in the pediatric setting: current status and new developments

INTRODUCTION: Invasive mold infections (IMIs) remain a leading cause of morbidity and mortality in susceptible pediatric populations. Numerous challenges exist in diagnosis and management, with limited pediatric clinical trial data. AREAS COVERED: The pediatric specific epidemiology of IMIs, current diagnostic and management approaches, and recommendations are presented. The potential role of isavuconazole, a newer triazole antifungal, is evaluated. EXPERT OPINION: Treatments for IMIs in pediatric patients include mold-active triazoles such as voriconazole and posaconazole, and liposomal amphotericin B. Isavuconazole has recently been approved for clinical use and will be a valuable addition to the antifungal armamentarium. Several agents with novel mechanisms of action are under development which show promise for the treatment of rare mold infections. Management principles in pediatric patients include prompt initiation of antifungal therapy, species identification and susceptibility testing, clinical evaluation of other infection sites, timely source control (e.g. surgery), control of conditions predisposing patients to IMIs, and administration of supportive therapies. The pharmacology, tolerability, and safety of the newer triazole isavuconazole has been established for the treatment of pediatric patients with IMIs with supportive efficacy data. However, further larger-cohort studies are warranted to define its role relative to the existing mold-active triazoles and liposomal amphotericin B.