title: [Combination antifungal therapy for invasive fungal disease in children with hematologic disease].
abstract: OBJECTIVE
  To evaluate antifungal combination strategy in children with hematologic diseases and invasive fungal disease( IFD).
  
  
  METHODS
  A retrospective clinical study was performed based on 67 childhood patients with hematologic diseases and IFD who firstly accepted combination antifungal therapy for ≥ 7 days during January 2012 and December 2014. Of them, 11 cases received combination of echinocandin with azole, 10 cases received combination of echinocandin with amphotericin B, and 46 cases received combination of azole with amphotericin B.
  
  
  RESULTS
  Overall response rate was 79.1%. Univariate analysis revealed that granulocyte recovery (P=0.031), status of underling disease (P=0.023) and the duration of the therapy (P=0.046) were significantly associated with efficacy. Multivariate analysis showed that the independent prognostic factor was the duration of combination antifungal therapy (OR=0.229, 95% CI 0.061- 0.863, P=0.029). The response rates of echinocandin combined with azole, echinocandin combined with amphotericin B and azole combined with amphotericin B were 81.8%, 60.0% and 82.6%, respectively (P>0.05), and 12-week survival rates were 81.8%, 80.0% and 86.5%, respectively (P>0.05). The drug- related adverse reactions occurred 59 times in 34 patients. BUN increasing, hypokalemia and abnormal liver functions were considered the main side effects.
  
  
  CONCLUSIONS
  For IFD in children with hematologic disease, to extend the duration of treatment (≥ 14 days) could significantly improve the curative effect. Combinations of echinocandin with azole, echinocandin with amphotericin B and azole with amphotericin B can be used as a combination treatment options. Combination of Azole with amphotericin B is efficacious, safe and economic treatment option considering efficacy, survival rate, cost and dosage form.
authors.affiliation: Department of Paediatrics, Sun Yat- sen Memorial Hospital of Sun Yat- sen University, Guangzhou 510120, China.
authors.forename: Kunyin
authors.initials: K
authors.lastname: Qiu
authors.affiliation: Department of Paediatrics, Sun Yat- sen Memorial Hospital of Sun Yat- sen University, Guangzhou 510120, China.
authors.forename: Lanlan
authors.initials: L
authors.lastname: Deng
authors.affiliation: Department of Paediatrics, Sun Yat- sen Memorial Hospital of Sun Yat- sen University, Guangzhou 510120, China.
authors.forename: Ke
authors.initials: K
authors.lastname: Huang
authors.affiliation: Department of Paediatrics, Sun Yat- sen Memorial Hospital of Sun Yat- sen University, Guangzhou 510120, China.
authors.forename: Haixia
authors.initials: H
authors.lastname: Guo
authors.affiliation: Department of Paediatrics, Sun Yat- sen Memorial Hospital of Sun Yat- sen University, Guangzhou 510120, China.
authors.forename: Jianpei
authors.initials: J
authors.lastname: Fang
authors.affiliation: Department of Paediatrics, Sun Yat- sen Memorial Hospital of Sun Yat- sen University, Guangzhou 510120, China.
authors.forename: Honggui
authors.initials: H
authors.lastname: Xu
authors.affiliation: Department of Paediatrics, Sun Yat- sen Memorial Hospital of Sun Yat- sen University, Guangzhou 510120, China.
authors.forename: Hongman
authors.initials: H
authors.lastname: Xue
authors.affiliation: Department of Paediatrics, Sun Yat- sen Memorial Hospital of Sun Yat- sen University, Guangzhou 510120, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Paediatrics, Sun Yat- sen Memorial Hospital of Sun Yat- sen University, Guangzhou 510120, China.
authors.forename: Chun
authors.initials: C
authors.lastname: Chen
authors.affiliation: Department of Paediatrics, Sun Yat- sen Memorial Hospital of Sun Yat- sen University, Guangzhou 510120, China.
authors.forename: Dunhua
authors.initials: D
authors.lastname: Zhou
mesh_terms: D000666:Amphotericin B / Q000008:administration & dosage / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D004359:Drug Therapy, Combination; D054714:Echinocandins / Q000008:administration & dosage / Q000627:therapeutic use*; D006402:Hematologic Diseases / Q000382:microbiology*; D006801:Humans; D009181:Mycoses / Q000188:drug therapy*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D000666:Amphotericin B