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Real-Life Use of Posaconazole in Clinical Practice for Onco-Hematological Children: A National Survey by AIEOP

Lorenzo Chiusaroli1, Manuela Spadea2, Cecilia Liberati1

  • 1Division of Pediatric Infectious Diseases, Department for Women's and Children's Health, University Hospital of Padua, 35128 Padova, Italy.

Journal of Fungi (Basel, Switzerland)
|November 26, 2025
PubMed

Insights

Posaconazole is widely used for antifungal prophylaxis and treatment in pediatric cancer patients across Italy. However, its application varies significantly between centers, highlighting the need for standardized protocols.

Area of Science:

  • Pediatric Hematology-Oncology
  • Infectious Diseases
  • Pharmacology

Background:

  • Posaconazole is an antifungal approved for invasive fungal infections (IFI) in pediatric onco-hematological patients.
  • Recent pediatric approval means limited data and applicable limitations exist.
  • Safety and efficacy appear favorable in children, prompting further investigation into its use.

Purpose of the Study:

  • To describe the current utilization of posaconazole in pediatric cancer patients within the Associazione Italiana Ematologia e Oncologia Pediatrica (AIEOP) network.
  • To identify patterns in posaconazole prophylaxis and treatment across Italian pediatric hematology-oncology centers.
  • To assess the variability in posaconazole formulations, indications, and monitoring practices.

Main Methods:

  • A national survey was conducted among physicians in the AIEOP network.
  • A 25-item web questionnaire assessed posaconazole use in pediatric cancer patients, including those undergoing hematopoietic stem cell transplantation (HSCT).
  • Descriptive statistics were used to analyze the collected data.

Main Results:

  • Sixty-eight percent of AIEOP centers responded, indicating availability of oral suspension, delayed-release tablets, and intravenous posaconazole.
  • Primary uses included prophylaxis for acute lymphoblastic leukemia (38%), acute myeloid leukemia (38%), and aplastic anemia (19%).
  • Posaconazole was also used for secondary prophylaxis and salvage therapy, with common but varied drug plasma level monitoring and discontinuation due to drug-drug interactions.

Conclusions:

  • Posaconazole is extensively utilized in AIEOP centers for pediatric onco-hematological patients.
  • Significant variability exists in its application, including indications, dosing, and monitoring.
  • Prospective studies are essential to establish standardized protocols for optimal pediatric posaconazole use.
Abstract

Keywords:
childrenfungal infectionsposaconazolesurvey

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