Posaconazole plasma concentrations in pediatric patients receiving antifungal prophylaxis during neutropenia

Area of Science:

• Pediatric Oncology
• Infectious Diseases
• Pharmacology

Background:

• Invasive fungal infections pose a significant risk to pediatric patients experiencing prolonged neutropenia post-chemotherapy.
• Limited data exists on the efficacy and safety of posaconazole for this specific patient group.

Purpose of the Study:

• To evaluate the trough concentrations, safety, and feasibility of prophylactic posaconazole oral suspension in pediatric patients with neutropenia.
• To assess the relationship between posaconazole levels and clinical outcomes in this population.

Main Methods:

• A multicenter survey analyzed 172 posaconazole trough levels from 33 pediatric patients (median age 8 years) across 108 neutropenic episodes.
• Patient demographics, adverse events, and hepatic parameters (ALT, AST) were monitored.

Main Results:

• Median posaconazole trough concentration was 438 ng/ml, with no influence from age or gender.
• Posaconazole was well-tolerated, with no discontinuations due to adverse events. Hepatic enzymes (ALT, AST) showed significant increases.
• One patient with a median trough concentration of 306 ng/ml experienced an invasive fungal infection.

Conclusions:

• Posaconazole is effective, safe, and feasible for prophylaxis in pediatric neutropenia lasting ≥5 days post-chemotherapy.
• Median plasma concentrations were lower than the recommended 700 ng/ml.
• Larger studies are required to validate these findings and optimize posaconazole use in pediatric oncology.