title: Antifungal prophylaxis with posaconazole vs. fluconazole or itraconazole in pediatric patients with neutropenia.
abstract: Pediatric patients with hemato-oncological malignancies and neutropenia resulting from chemotherapy have a high risk of acquiring invasive fungal infections. Oral antifungal prophylaxis with azoles, such as fluconazole or itraconazole, is preferentially used in pediatric patients after chemotherapy. During this retrospective analysis, posaconazole was administered based on favorable results from studies in adult patients with neutropenia and after allogeneic hematopoietic stem cell transplantation. Retrospectively, safety, feasibility, and initial data on the efficacy of posaconazole were compared to fluconazole and itraconazole in pediatric and adolescent patients during neutropenia. Ninety-three pediatric patients with hemato-oncological malignancies with a median age of 12 years (range 9 months to 17.7 years) that had prolonged neutropenia (>5 days) after chemotherapy or due to their underlying disease, and who received fluconazole, itraconazole, or posaconazole as antifungal prophylaxis, were analyzed in this retrospective single-center survey. The incidence of invasive fungal infections in pediatric patients was low under each of the azoles. One case of proven aspergillosis occurred in each group. In addition, there were a few cases of possible invasive fungal infection under fluconazole (n = 1) and itraconazole (n = 2). However, no such cases were observed under posaconazole. The rates of potentially clinical drug-related adverse events were higher in the fluconazole (n = 4) and itraconazole (n = 5) groups compared to patients receiving posaconazole (n = 3). Posaconazole, fluconazole, and itraconazole are comparably effective in preventing invasive fungal infections in pediatric patients. Defining dose recommendations in these patients requires larger studies.
authors: Department I-General Paediatrics, Hematology/Oncology, University Hospital Tuebingen, Children's Hospital, Hoppe-Seyler-Str. 1, 72076, Tuebingen, Germany, michaela.doering@med.uni-tuebingen.de.
authors: M
authors: M
authors: Döring
authors: M
authors: M
authors: Eikemeier
authors: K M
authors: KM
authors: Cabanillas Stanchi
authors: U
authors: U
authors: Hartmann
authors: M
authors: M
authors: Ebinger
authors: C-P
authors: CP
authors: Schwarze
authors: A
authors: A
authors: Schulz
authors: R
authors: R
authors: Handgretinger
authors: I
authors: I
authors: Müller
mesh_terms: D000293:Adolescent; D000935:Antifungal Agents / Q000008:administration & dosage* / Q000009:adverse effects; D018890:Chemoprevention / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology / Q000473:pathology; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D007223:Infant; D017964:Itraconazole / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D009181:Mycoses / Q000517:prevention & control*; D009369:Neoplasms / Q000150:complications; D009503:Neutropenia / Q000150:complications*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014230:Triazoles / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D000935:Antifungal Agents; D014230:Triazoles; D017964:Itraconazole; C101425:posaconazole; D015725:Fluconazole