儿科抗真菌药物的合理使用

Rational use of antifungal drugs in pediatrics

近20年来,随着广谱抗菌药物、免疫抑制剂、激素、抗肿瘤药物和靶向生物制剂的广泛应用以及真菌检测方法的不断改进,儿童侵袭性真菌病的发病率呈逐年上升趋势,侵袭性真菌病成为免疫低下儿童的主要死亡原因之一。除了原发性免疫缺陷、肿瘤、造血干细胞移植、实体器官移植及获得性免疫缺陷综合征病毒(HIV)感染等,婴幼儿本身也是真菌感染的高危因素。因此早期诊断、及时应用有效抗真菌药是挽救患儿生命的重要措施。儿童作为特殊人群,抗真菌药物的选择和剂量与成人不同,该文主要探讨如何选择合适的抗真菌药物来预防和治疗儿童真菌病。

There has been a significant increase in the incidence of invasive fungal disease in children over the past 20 years because of the widespread use of broad-spectrum antibiotics,immunosuppressants,hormones,anti-tumor drugs and targeted biological agents as well as the advance of fungal detection techniques.Invasive fungal disease is one of the leading causes of death in immunocompromised children.In addition to primary immune deficiency,hematopoietic stem cell transplantation,solid organ transplant and HIV,infants themselves are also a risk factor for fungal infections.Therefore,early diagnosis and prompt application of effective antifungal drugs are an important measure to save the lives of children.As a special population the selection and dosage of antifungal drugs for children are different from those for adults.In this review,we summarize the appropriate strategy of antifungal prophylaxis and treatment in children.