Korean J Clin Pharm.  2018 Sep;28(3):181-187. 10.24304/kjcp.2018.28.3.181.

Posaconazole for Prophylaxis of Fungal Infection in Pediatric Patients with Acute Myeloid Leukemia undergoing Induction Chemotherapy

Affiliations
  • 1Department of Pharmacy, Severance Hospital, Yon-sei University Health System, Seoul 03722, Republic of Korea. sespharm@yuhs.ac
  • 2Department of Pediatric Hematology Oncology, Severance Hospital, Yon-sei University Health System, Seoul 03722, Republic of Korea.

Abstract

BACKGROUND
Posaconazole is a broad-spectrum triazole antifungal agent and the most recommended prophylactic antifungal agent for patients with acute myeloid leukemia (AML) undergoing induction chemotherapy. In this study, we evaluated the status and effectiveness of posaconazole as a prophylactic antifungal agent in pediatric patients receiving induction chemotherapy for AML.
METHODS
We retrospectively reviewed the electronic medical records of 36 pediatric patients with AML (between January 2013 and September 2017) at the Yonsei University Health System. Invasive fungal disease (IFD) was assessed as the primary endpoint of prophylactic antifungal effect. The secondary endpoints were incidence of fever, persistent fever despite the use of broad-spectrum antibiotics for 72 h, alteration of antifungal agent, intensive care unit admission, and death within 100 days.
RESULTS
Among the 36 patients, 18 patients used posaconazole, 12 were treated with suspension formula, and 6 of them were treated with tablets. Eighteen patients did not use antifungal agents prophylactically. The mean number of days of posaconazole administration was 26.8±16 days. IFD occurred in 2/18 (11.1%) patients in the no prophylaxis group and in 1/18 (5.6%) patients in the posaconazole group (p=0.49).
CONCLUSION
Posaconazole is expected to be useful for the prevention of IFD in pediatric patients with AML undergoing induction chemotherapy. Prospective studies of the effectiveness of posaconazole prophylaxis should be conducted in more pediatric patients in the future.

Keyword

Posaconazole; antifungal prophylaxis; pediatrics; acute myeloid leukemia

MeSH Terms

Anti-Bacterial Agents
Antifungal Agents
Electronic Health Records
Fever
Humans
Incidence
Induction Chemotherapy*
Intensive Care Units
Leukemia, Myeloid, Acute*
Pediatrics
Prospective Studies
Retrospective Studies
Tablets
Anti-Bacterial Agents
Antifungal Agents
Tablets
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