Intravenous antifungal therapy for invasive pulmonary aspergillosis in children
For children 2 years or older with invasive pulmonary aspergillosis, voriconazole is the preferred antifungal. Consider initial therapy with amphotericin B liposomal in a child 2 years or older if azoles are contraindicated (eg due to drug interactions) or the child developed invasive pulmonary aspergillosis develops while taking an azole for mould prophylaxis – seek expert advice.
For children younger than 2 years with invasive pulmonary aspergillosis, amphotericin B liposomal is preferred because the Therapeutic Goods Administration (TGA) has not approved use of voriconazole in this age group.
Do not use liposomal amphotericin B for Aspergillus species with amphotericin resistance (eg A. terreus, A. nidulans).
For invasive pulmonary aspergillosis in children younger than 2 years, use:Douglas, 2021
amphotericin B liposomal 3 mg/kg intravenously, daily. See advice on modification and duration of therapy. amphotericin b liposomal
For invasive pulmonary aspergillosis in children 2 years or older, use:Douglas, 2021
1voriconazole intravenously1. Monitor plasma concentration. See advice on modification and duration of therapy voriconazole
child 2 to younger than 12 years: 9 mg/kg, 12-hourly for 2 doses, followed by 8 mg/kg intravenously, 12-hourly
child 12 to younger than 15 years and less than 50 kg: 9 mg/kg, 12-hourly for 2 doses, followed by 8 mg/kg intravenously, 12-hourly
child 12 to younger than 15 years and 50 kg or more: 6 mg/kg, 12-hourly for 2 doses, followed by 4 mg/kg intravenously, 12-hourly
child 15 years or older: 6 mg/kg, 12-hourly for 2 doses, followed by 4 mg/kg intravenously, 12-hourly
OR
2amphotericin B liposomal 3 mg/kg intravenously, daily. See advice on modification and duration of therapy. amphotericin b liposomal