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Antifungal Prophylaxis With Posaconazole in Immunocompromised Children Younger Than 13 Years

Julio Maquera-Afaray1,2, Medalit Luna-Vilchez1, Blanca Salazar-Mesones1

  • 1Unidad de Atención Integral Especializada (JM-A, ML-V, BS-M, DP-A, LU-R, GT-S, CS-S, JWL), Instituto Nacional de Salud del Niño San Borja, Lima, Perú.

The Journal of Pediatric Pharmacology and Therapeutics : JPPT : the Official Journal of PPAG
|January 10, 2022
PubMed

Insights

Posaconazole prophylaxis in children with hematologic diseases showed increased transaminase levels and breakthrough fungal infections. Further research is needed to evaluate its safety and efficacy in this pediatric population.

Area of Science:

  • Pediatric Hematology
  • Infectious Diseases
  • Pharmacology

Background:

  • Invasive fungal infections (IFIs) pose a significant risk to immunocompromised patients.
  • Posaconazole prophylaxis (PP) is established for adults but data in children is limited.
  • Understanding PP's use in pediatric hematology is crucial for optimizing patient care.

Purpose of the Study:

  • To describe the utilization of posaconazole as antifungal prophylaxis in pediatric patients.
  • To evaluate the safety and effectiveness of PP in immunocompromised children.
  • To identify potential adverse events and breakthrough infections associated with PP in this cohort.

Main Methods:

  • Retrospective review of medical records for pediatric patients (<13 years) receiving PP.
  • Inclusion criteria: hematologic diseases and post-hematopoietic stem cell transplant (HSCT).
  • Data collected from January 2014 to December 2018 at a tertiary care center in Peru.

Main Results:

  • 47 patients received 56 courses of PP; median age 7.5 years.
  • Common conditions: aplastic anemia, acute lymphoblastic leukemia, acute myeloid leukemia; 34.1% post-HSCT.
  • Adverse events included elevated transaminases (25.7% AST, 19.6% ALT); 8.9% experienced breakthrough fungal infections.

Conclusions:

  • Posaconazole prophylaxis in pediatric patients (<13 years) was associated with increased transaminase levels.
  • Breakthrough fungal infections occurred in a subset of patients despite prophylaxis.
  • Further studies are warranted to refine dosing and monitor outcomes in pediatric populations receiving PP.
Abstract

Keywords:
antifungal prophylaxishematologic diseasepediatric patientsposaconazole

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