Antifungal combination therapy for invasive fungal infections in a paediatric oncology and haematology department: A retrospective analysis of practice - 17/08/22
Abstract |
Background |
Invasive fungal infections (IFI) are an important cause of morbidity and mortality in children with leukaemia. International guidelines recommend a monotherapy for most IFI. The use of antifungal combination therapy (ACT) has been reported, but clinical data supporting these combinations are scarce, particularly in paediatrics.
Objective |
To describe, among patients treated in our department, the situations in which an ACT was used.
Results |
Between January 2017 and December 2020, 239 patients (406 hospital stays) benefited from systemic antifungals. Among them, ACT was prescribed for 14 (5.9%) patients (13 leukaemia, 1 aplastic anaemia) corresponding to 16 (3.9%) hospital stays. IFI cases treated with ACT were mainly proven (n=9) or probable (n=4). Seven cases required admission to the intensive care unit. The most commonly used antifungal agents were liposomal amphotericin B (n=13), caspofungin (n=12) and voriconazole (n=9). In 13 cases, monotherapy was prescribed as first-line therapy and changed to an ACT for an uncontrolled infection. But in 3 cases, the ACT was started immediately. The response at 12 weeks after diagnosis of proven/probable IFI was successful in 12 cases (92.3%). The only IFI-related death was attributed to disseminated mucormycosis. ACT were generally well tolerated. In 4 cases, adverse events led to the discontinuation of the offending antifungal agent.
Conclusion |
This retrospective analysis of practices shows that the use of ACT in our paediatric haemato-oncology department is rare, and concerns the most severe cases and/or those not responding to the first line treatment. In most cases, ACT was efficient and well tolerated.
El texto completo de este artículo está disponible en PDF.Keywords : Invasive fungal infection, Antifungal agents, Combination therapy, Leukemia, Children
Esquema
Vol 32 - N° 3
Artículo 101276- août 2022 Regresar al númeroBienvenido a EM-consulte, la referencia de los profesionales de la salud.
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