ANTIFUNGAL PROPHYLAXIS WITH POSACONAZOLE IN IMMUNOCOMPROMISED CHILDREN
UNDER 13 YEARS OF AGE IN A REFERENCE HOSPITAL IN LIMA, PERU
Abstract
Background: Prophylaxis with posaconazole (PP) has shown to be effective
in the prevention of invasive fungal infections in immunocompromised
adult patients. However, evaluation of its effectiveness and safety in
children is limited. The aim of the study was to describe the use of
posaconazole as antifungal prophylaxis in children. Methods: We reviewed
the medical records of immunocompromised patients under 13 years of age
with hematological diseases and post hematopoietic stem cell
transplantation (HSCT) who received antifungal PP at the Instituto
Nacional de Salud del Niño San Borja (Perú) from January 2014 to
December 2018. Results: Fifty-six antifungal prophylaxis events were
identified in 47 patients with a median age of 7.5 years (interquartile
range [IQR] 4-10), 51.6% (n=24) of whom were female. The main
underlying medical conditions were aplastic anemia (n=19, 33.9%), acute
lymphoblastic leukemia (n=18, 32.1%), acute myeloid leukemia (n=14,
25.0%), and 34.1% had undergone HSCT. The median dose of posaconazole
was 13.62 mg/kg/day (IQR: 12.0-16.8), and the median duration of PP was
24 days (IQR: 16-82). Gastrointestinal symptoms included abdominal pain
(17.9%), nausea (16.1%), diarrhea (7.1%) and vomiting (3.6%).
Elevated alanine aminotransferase and aspartate aminotransferase levels
were observed in 9/35 patients (25.7%) and 10/51 (19.6%) patients,
respectively. Five cases of breakthrough fungal infection were
identified (8.9%). Conclusions: Breakthrough fungal infection,
increased transaminase levels and gastrointestinal symptoms were
observed during PP in children under 13 years of age.