INTRODUCTION
The use of prophylactic antifungals has dramatically decreased the risk
of the development of invasive fungal infections (IFIs) in cancer
patients and patients undergoing hematopoietic stem cell transplantation
(HSCT) being a major cause of morbidity and mortality (1,2).
Posaconazole is a triazole-extended spectrum used primarily for the
prophylaxis and treatment of IFIs refractory to other antifungal
therapies, due to its extensive coverage of yeast and filamentous fungi,
and has shown to be effective in adolescents and adults (2-4). This drug
is only approved for use in adults in Europe, and the oral suspension is
approved by the Food and Drug Administration (FDA) only in individuals
over 13 years of age (3,4). The recommendation for the use of
posaconazole in children under 13 years of age is limited to individual
cases as an ”off- label” prescription (5). Therefore, the use of
posaconazole in prophylaxis (PP) in children has not been fully
evaluated, and this is important since the underlying risk of drug
toxicity and poor adherence to the drug could impact the failure of
prophylaxis, increasing the risk of breakthrough fungal infection
(3–5).Nonetheless, while the efficacy, safety, and pharmacokinetic
characteristics of posaconazole as a prophylactic alternative have been
evaluated in high-risk pediatric patients (6,7), it is only recommended
for use in patients over the age of 13 years, unlike other antifungal
drugs such as fluconazole, itraconazole, and voriconazole (6,7).
The aim of this study was to describe our experience with PP in children
under 13 years of age with hematological diseases who had undergone HSCT
at the Instituto Nacional de Salud del Niño San Borja (INSN-SB)
in Lima, Peru.