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Combination antifungal therapy for Scedosporium species in cystic fibrosis

Siân Bentley1, Jane C Davies2,3, Siobhán B Carr2

  • 1Department of Pharmacy, Royal Brompton Hospital, London, UK.

Pediatric Pulmonology
|April 28, 2020
PubMed

Insights

Oral posaconazole and terbinafine combination therapy was well-tolerated in children with cystic fibrosis but did not eradicate Lomentospora prolificans or Scedosporium apiospermum infections. Lung function effects were variable but encouraging.

Area of Science:

  • Medical Mycology
  • Pediatric Infectious Diseases
  • Pharmacotherapy

Background:

  • Cystic fibrosis (CF) patients are susceptible to fungal infections.
  • Lomentospora prolificans and Scedosporium apiospermum are emerging pathogens in CF.
  • Limited treatment options exist for these infections in pediatric populations.

Observation:

  • A retrospective case review of five children with CF treated for L. prolificans or S. apiospermum infections.
  • Median age was 15.0 years, with treatment duration averaging 5 months.
  • Patients received combination oral therapy with posaconazole and terbinafine.

Findings:

  • No patients achieved complete eradication of the fungal infections.
  • Lung function showed variable but encouraging responses to treatment.
  • The combination therapy was generally well-tolerated, with one case of transient liver enzyme elevation.

Implications:

  • Combination oral posaconazole and terbinafine is a safe option for CF patients with these fungal infections.
  • Current therapeutic regimens may not be sufficient for complete fungal eradication.
  • Further research is needed to optimize antifungal strategies for L. prolificans and S. apiospermum in CF.
Abstract

Keywords:
Lomentospora prolificansScedosporium apiospermumantifungalcystic fibrosisposaconazoleterbinafine

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