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Open Access Highly Accessed Research article

Analysis of posaconazole as oral antifungal prophylaxis in pediatric patients under 12 years of age following allogeneic stem cell transplantation

Michaela Döring1*, Carsten Müller2, Pascal-David Johann3, Annika Erbacher1, Astrid Kimmig1, Carl-Philipp Schwarze1, Peter Lang1, Rupert Handgretinger1 and Ingo Müller4

Author affiliations

1 Department of Pediatric Hematology and Oncology, University Children’s Hospital Tübingen, Hoppe-Seyler-Str.1, Tübingen, 72076, Germany

2 Department of Therapeutic Drug Monitoring, Institute of Pharmacology, University of Cologne, Gleueler Str. 24, Cologne, 50931, Germany

3 Department of Pediatric Oncology, Hematology and Immunology, University of Heidelberg, Im Neuenheimer Feld 430, Heidelberg, 69120, Germany

4 Clinic of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, 20246, Germany

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Citation and License

BMC Infectious Diseases 2012, 12:263  doi:10.1186/1471-2334-12-263

Published: 19 October 2012

Abstract

Background

Pediatric patients undergoing hematopoietic stem cell transplantation (HSCT) are at high risk of acquiring fungal infections. Antifungal prophylaxis shortly after transplantation is therefore indicated, but data for pediatric patients under 12 years of age are scarce. To address this issue, we retrospectively assessed the safety, feasibility, and initial efficacy of prophylactic posaconazole in children.

Methods

60 consecutive pediatric patients with a median age of 6.0 years who underwent allogeneic HSCT between August 2007 and July 2010 received antifungal prophylaxis with posaconazole in the outpatient setting. 28 pediatric patients received an oral suspension at 5 mg/kg body weight b.i.d., and 32 pediatric patients received the suspension at 4 mg/kg body weight t.i.d. The observation period lasted from start of treatment with posaconazole until its termination (maximum of 200 days post-transplant).

Results

Pediatric patients who received posaconazole at 4 mg/kg body weight t.i.d. had a median trough level of 383 μg/L. Patients who received posaconazole at 5 mg/kg body weight b.i.d. had a median trough level of 134 μg/L. Both regimens were well tolerated without severe side effects. In addition, no proven or probable invasive mycosis was observed.

Conclusion

Posaconazole was a well-tolerated, safe, and effective oral antifungal prophylaxis in pediatric patients who underwent high-dose chemotherapy and HSCT. Posaconazole at a dosage of 12 mg/kg body weight divided in three doses produced consistently higher morning trough levels than in patients who received posaconazole 5 mg/kg body weight b.i.d. Larger prospective trials are needed to obtain reliable guidelines for antifungal prophylaxis in children after HSCT.

Keywords:
Posaconazole; Posaconazole trough levels; Pediatric patients; Antifungal prophylaxis; Stem cell transplantation