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[Drugs used in prophylaxis and treatment of fungal infections in immunosuppressed children].

Contemporary treatment of cancer (intensive chemotherapy, radiotherapy, radical surgery, stem cell transplantation) and severe non-neoplastic blood diseases resulted in significant improvement of treatment results. Currently over 70% of children with cancer can be cured. However, at the same time number of severe complications, including life-threatening infections began to increase. In recent years fungal infections, which constitute approximately 10% of all infections, emerged as an important issue. Their most common etiology is Candida (>85%) and Aspergillus (approx. 1.5%). Fungal infections still result in high mortality (50-95%) in immuno-suppressed patients. Thus it is important to improve diagnosis and prophylaxis, as well as to optimize treatment. Results of treatment of deep organ fungal infections are still unsatisfactory. Currently used drugs show multiple organ toxicity, which limits their use in sufficiently high and effective doses. It is possible to decrease toxicity of currently known drugs, like amphotericin B, by using liposomal formulations. This allows for significant increase of the effective dose without increasing toxicity and improves the drug therapeutic index. There is extensive research on new generations of antifungal drugs whose mechanism of actions is based on specific, unique properties of fungal cells. Preliminary results of research on caspofungin and voriconazole are promising. Important factors improving results of treatment of deep organ fungal infections are so-called immunomodulators. Our presentation will review currently available antifungal drugs and guidelines for treatment of specific fungal infections. The plan of antifungal treatment must include not only the species of fungal pathogen, but also the site and extent of infection, as well as patient status, including stage of primary disease, previous therapy and previous organ damage. Rational management would allow to choose appropriate antifungal drug, optimize dosage and duration of treatment and estimated costs, and above all to improve the chance to effectively control the life-threatening fungal infections.