Comparison of itraconazole, voriconazole, and posaconazole as oral antifungal prophylaxis in pediatric patients following allogeneic hematopoietic stem cell transplantation

• Published in: European journal of clinical microbiology & infectious diseases 2014-04, Vol.33 (4), p.629-638
• Main Authors: Döring, M., Blume, O., Haufe, S., Hartmann, U., Kimmig, A., Schwarze, C.-P., Lang, P., Handgretinger, R., Müller, I.
• Format: Article
• Language: English
• Subjects: Administration, Oral; Adolescent; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antibiotic Prophylaxis - methods; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antifungal agents; Antifungal Agents - therapeutic use; Biological and medical sciences; Biomedical and Life Sciences; Biomedicine; Bone marrow; Bone marrow, stem cells transplantation. Graft versus host reaction; Chemotherapy; Child; Child, Preschool; Disease prevention; Female; Fungal infections; Graft versus host disease; Hematology; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic Stem Cell Transplantation - methods; Hospitals; Humans; Infant; Infectious diseases; Internal Medicine; Male; Medical Microbiology; Medical sciences; Neutropenia; Oncology; Pediatrics; Pharmacology. Drug treatments; Postoperative Complications - drug therapy; Postoperative Complications - prevention & control; Prophylaxis; Stem cell transplantation; Stem cells; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Transplantation, Homologous; Triazoles - therapeutic use; Viral infections
• ISSN: 0934-9723; 1435-4373
• DOI: 10.1007/s10096-013-1998-2

Oral antifungal prophylaxis with extended-spectra azoles is widely used in pediatric patients after allogeneic hematopoietic stem cell transplantation (HSCT), while controlled studies for oral antifungal prophylaxis after bone marrow transplantation in children are not available. This survey analyzed patients who had received either itraconazole, voriconazole, or posaconazole. We focused on the safety, feasibility, and initial data of efficacy in a cohort of pediatric patients and adolescents after high-dose chemotherapy and HSCT. Fifty consecutive pediatric patients received itraconazole, 50 received voriconazole, and 50 pediatric patients received posaconazole after HSCT as oral antifungal prophylaxis. The observation period lasted from the start of oral prophylactic treatment with itraconazole, voriconazole, or posaconazole until two weeks after terminating the oral antifungal prophylaxis. No incidences of proven or probable invasive mycosis were observed during itraconazole, voriconazole, or posaconazole treatment. A total of five possible invasive fungal infections occurred, two in the itraconazole group (4 %) and three in the voriconazole group (6 %). The percentage of patients with adverse events potentially related to clinical drugs were 14 % in the voriconazole group, 12 % in the itraconazole group, and 8 % in the posaconazole group. Itraconazole, voriconazole, and posaconazole showed comparable efficacy as antifungal prophylaxis in pediatric patients after allogeneic HSCT.