title: Voriconazole as primary antifungal prophylaxis in children undergoing allo-SCT.
abstract: Invasive fungal disease (IFD) causes significant morbidity and mortality among children undergoing allo-SCT. In this prospective pilot study, we analyze voriconazole as primary antifungal prophylaxis. From October 2004 to July 2010, 56 children <18 years of age were enrolled in this study. Patients received voriconazole doses of 5 mg/kg per 12 h (n=23) or 7 mg/kg per 12 h (n=33), with a limiting dose of 200 mg/12 h, from day -1 to day +75 or later in patients with active acute GVHD. Patients were followed up for IFD for 6 months. In this series, 37 (66.1%) patients successfully completed treatment (85.7% during neutropenic period) without empirical or preemptive antifungal therapy, adverse effects or IFD. Nine (16.1%) children needed preemptive (n=2) or empirical (n=7) antifungal therapy, and one (1.8%) of them developed a fatal probable IFD during the study period. A total of 10 (17.8%) children developed adverse effects related to voriconazole prophylaxis, leading to definitive withdrawal on median day 26.5 (in 7 patients after granulocytic recovery). The most frequent adverse effect was persistent elevation of hepatic enzymes in seven (12.5%) children. There were no differences between doses of 5 and 7 mg/kg per 12 h. Our results suggest that voriconazole can be safely used as primary antifungal prophylaxis in children undergoing allo-SCT.
authors.affiliation: Department of Hematology, Bone Marrow Transplantation Unit, and Instituto Maimonides Investigación Biomédica (IMIBIC), University Hospital Reina Sofia, Cordoba, Spain. josehristomoli@yahoo.es
authors.forename: J R
authors.initials: JR
authors.lastname: Molina
authors.forename: J
authors.initials: J
authors.lastname: Serrano
authors.forename: J
authors.initials: J
authors.lastname: Sánchez-García
authors.forename: A
authors.initials: A
authors.lastname: Rodríguez-Villa
authors.forename: P
authors.initials: P
authors.lastname: Gómez
authors.forename: D
authors.initials: D
authors.lastname: Tallón
authors.forename: V
authors.initials: V
authors.lastname: Martín
authors.forename: G
authors.initials: G
authors.lastname: Rodríguez
authors.forename: R
authors.initials: R
authors.lastname: Rojas
authors.forename: C
authors.initials: C
authors.lastname: Martín
authors.forename: F
authors.initials: F
authors.lastname: Martínez
authors.forename: M A
authors.initials: MA
authors.lastname: Alvarez
authors.forename: A
authors.initials: A
authors.lastname: Torres
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000935:Antifungal Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D005260:Female; D006086:Graft vs Host Disease / Q000188:drug therapy; D006402:Hematologic Diseases / Q000628:therapy; D006801:Humans; D008297:Male; D009181:Mycoses / Q000517:prevention & control*; D011743:Pyrimidines / Q000008:administration & dosage* / Q000009:adverse effects; D033581:Stem Cell Transplantation; D013997:Time Factors; D014230:Triazoles / Q000008:administration & dosage* / Q000009:adverse effects; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole