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Voriconazole in childrens

Elena M Marín Martínez, Ana Isabel Aller García, Estrella Martín-Mazuelos
BACKGROUND: Invasive fungal infection (IFI) has increased in recent years due to there being a greater number of risk factors. IFI caused by Candida is the most frequent, and although Candida albicans is the most isolated species, there is currently a decrease of C. albicans and an increase of other species of the genus. AIMS: To analyse the epidemiology, risk factors, and antifungal susceptibility of blood culture isolates of non-C.albicans Candida species in our hospital in the last 12years...
October 13, 2016: Revista Iberoamericana de Micología
Tracy N Zembles, Nathan E Thompson, Peter L Havens, Bruce A Kaufman, Anna R Huppler
STUDY OBJECTIVE: To describe our experience with voriconazole in three patients younger than 2 years using an optimized dosing strategy for voriconazole that incorporates intensive therapeutic drug monitoring (TDM). DESIGN: Case series. SETTING: Large pediatric hospital. PATIENTS: Three patients younger than 2 years who received voriconazole therapy and had serum trough concentrations measured between January 1, 2010, and October 31, 2015...
October 2016: Pharmacotherapy
Kathleen M Job, Jared Olson, Chris Stockmann, Jonathan E Constance, Elena Y Enioutina, Joseph E Rower, Matthew W Linakis, Alfred H Balch, Tian Yu, Xiaoxi Liu, Emily A Thorell, Catherine M T Sherwin
INTRODUCTION: Voriconazole is a broad-spectrum antifungal agent commonly used to treat invasive fungal infections (IFI), including aspergillosis, candidiasis, Scedosporium infection, and Fusarium infection. IFI often occur in immunocompromised patients, leading to increased morbidity and mortality. AREAS COVERED: The objective of this review is to summarize the pharmacodynamic properties of voriconazole and to provide considerations for potential optimal dosing strategies...
August 2016: Expert Review of Anti-infective Therapy
Hirozumi Sano, Ryoji Kobayashi, Daiki Hori, Kenji Kishimoto, Daisuke Suzuki, Kazue Yasuda, Kunihiko Kobayashi
BACKGROUND: Pediatric patients under treatment for acute myeloid leukemia (AML) are at high risk for invasive fungal infection (IFI). We evaluated the efficacy of prophylactic administration of voriconazole (VRCZ) with two different doses. METHODS: Between October 2005 and June 2011, 17 children and adolescents (aged 0-20 years) undergoing chemotherapy for AML were prophylactically administered with 5 mg/kg/d of oral VRCZ. Furthermore, 22 AML patients (aged 0-19 years) were administered 10 mg/kg/d of oral VRCZ between July 2011 and December 2014...
June 2, 2016: Journal of Microbiology, Immunology, and Infection, Wei Mian Yu Gan Ran za Zhi
Sahana M Srinivas, Vykuntaraju K Gowda, S Mahantesh, Rajeshwari Mannapur, Sanjay K Shivappa
Chromoblastomycosis is a chronic granulomatous infection of the skin and subcutaneous tissue caused by specific group of dematiaceous fungi. The infection results from traumatic injury and is seen more commonly on feet and lower legs. It is rarely seen in children and metastatic spread to other systems is exceptionally rare. We report a 12-year-old immunocompetent male child diagnosed with chromoblastomycosis on the lower leg, who in a span of few months developed osteomyelitis and left hemiparesis. Fungal culture showed growth of Exophiala spinifera...
May 2016: Indian Journal of Dermatology
Nawal Al-Maskari, Ibrahim Hussain, Suleiman Jumaa, Essam A Al-Shail
Intracranial aspergillosis is an extremely rare manifestation of invasive aspergillosis in immunocompetent children and is associated with high morbidity and mortality. We report a 12-year-old immunocompetent male child who was referred to the King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia, in May 2010 after a sudden-onset headache and loss of consciousness. Brain imaging revealed a large right space-occupying occipital lesion and the patient underwent a craniotomy and resection. Histopathology of the lesion revealed necrotising granulomatous fungal encephalitis with many hyphae engulfed by multinucleated giant histiocytes...
May 2016: Sultan Qaboos University Medical Journal
Gaoqi Xu, Liqin Zhu, Tingyue Ge, Shasha Liao, Na Li, Fang Qi
The objective of this study was to investigate the cumulative fraction of response of various voriconazole dosing regimens against six Candida and six Aspergillus spp. in immunocompromised children, immunocompromised adolescents, and adults. Using pharmacokinetic parameters and pharmacodynamic data, 5000-subject Monte Carlo simulations (MCSs) were conducted to evaluate the ability of simulated dosing strategies in terms of fAUC/MIC targets of voriconazole. According to the results of the MCSs, current voriconazole dosage regimens were all effective for children, adolescents and adults against Candida albicans, Candida parapsilosis and Candida orthopsilosis...
April 22, 2016: International Journal of Antimicrobial Agents
Nelesh P Govender, Jaymati Patel, Rindidzani E Magobo, Serisha Naicker, Jeannette Wadula, Andrew Whitelaw, Yacoob Coovadia, Ranmini Kularatne, Chetna Govind, Shawn R Lockhart, Inge L Zietsman
OBJECTIVES: To compare Candida species distribution and antifungal susceptibility at South African public- and private-sector hospitals. METHODS: From February 2009 through to August 2010, laboratory-based surveillance for candidaemia was undertaken at 11 public-sector hospitals and >85 private-sector hospitals across South Africa. A case was defined as a patient of any age admitted to a sentinel hospital with isolation of Candida species from blood culture. Viable isolates were identified and tested for antifungal susceptibility at a reference laboratory...
July 2016: Journal of Antimicrobial Chemotherapy
Alison Boast, Nigel Curtis, Noel Cranswick, Amanda Gwee
OBJECTIVES: Therapeutic drug monitoring (TDM) of voriconazole is recommended to achieve trough concentrations of 1-5 mg/L. In children, this is challenging due to age-related variability in voriconazole pharmacokinetics. This study describes our experience with voriconazole, focusing on dosing regimens, dose adjustment and TDM. METHODS: We reviewed the medical records of immunocompromised children who received voriconazole from July 2009 to January 2015 and had TDM...
July 2016: Journal of Antimicrobial Chemotherapy
Te-Fu Weng, Kang-Hsi Wu, Han-Ping Wu, Ching-Tien Peng, Yu-Hua Chao
BACKGROUND: Invasive aspergillosis (IA) has recently increased and has a high mortality rate in immunocompromised patients. IA before hematopoietic stem cell transplantation (HSCT) is not uncommon, but how to cope with it is very tough. The serum aspergillus galactomannan antigen (GM) is a helpful marker for diagnosis of IA, and a serial follow-up of GM levels is important to evaluate the response of treatment. However, data on the changes of GM during HSCT are very limited. CASE PRESENTATION: Patient 1 was a 2-year-old female with severe aplastic anemia...
2016: Italian Journal of Pediatrics
Yong Li, Guangmin Nong, Min Jiang, Jing Liu, Xiuan Liang
OBJECTIVE: To investigate the diagnosis and treatment of invasive pulmonary aspergillosis (IPA) in children. METHOD: The clinical data of 16 cases of proven or probable IPA who had been in our Hospital from January 2006 to June 2014 were retrospectively analyzed. RESULT: Among the 16 patients, 11 were males and 5 were females. One child had proven IPA and 15 children had probable IPA. Host risk included long duration use of multiple broad-spectrum antibiotics in 16 cases, neutropenia in 9 cases, invasive mechanical ventilation in 3 cases, primary immunodeficiency disease in 2 cases, long-term use of glucocorticoids in 2 cases, measles in 2 cases, and congenital pulmonary hypoplasia in 1 case...
March 2016: Zhonghua Er Ke za Zhi. Chinese Journal of Pediatrics
Luc J Huurneman, Michael Neely, Anette Veringa, Fernando Docobo Pérez, Virginia Ramos-Martin, Wim J Tissing, Jan-Willem C Alffenaar, William Hope
Voriconazole is the agent of choice for the treatment of invasive aspergillosis in children at least 2 years of age. The galactomannan index is a routinely used diagnostic marker for invasive aspergillosis and can be useful for following the clinical response to antifungal treatment. The aim of this study was to develop a pharmacokinetic-pharmacodynamic (PK-PD) mathematical model that links the pharmacokinetics of voriconazole with the galactomannan readout in children. Twelve children receiving voriconazole for treatment of proven, probable, and possible invasive fungal infections were studied...
April 2016: Antimicrobial Agents and Chemotherapy
Jessica M Lee, Ana Lia Graciano, Lukasz Dabrowski, Brenik Kuzmic, Mary Anne Tablizo
INTRODUCTION: In contrast to adults, coccidioidomycosis is a rare disease in infants and the mechanisms of disease acquisition are not well described in infants. The purpose of this study was to describe the clinical presentation, treatment, and outcome of pulmonary coccidioidomycosis in infants in an endemic area. METHODS: We performed a retrospective observational study of all patients less than 12 months of age admitted to a tertiary free standing children's hospital from 2003-2012 diagnosed with coccidioidomycosis...
August 2016: Pediatric Pulmonology
Adel A Hagag, Samir M Hassan, Mohamed A Elgamasy, Ibtesam K Afifi
BACKGROUND: Infection 'is a common complication in children with hematological malignancies' during febrile neutropenia. ' OBJECTIVE: The aim of this study was to' evaluate common bacterial and fungal pathogens in children with hematological malignancies during febrile neutropenia in single center Egyptian study. ' PATIENTS AND METHODS: This study was carried out on 90' children with hematological malignancies during febrile neutropenia including 54 with ALL, 27 with AML and 9 with NHL with their ages ranging from 2...
2016: Infectious Disorders Drug Targets
Saad J Taj-Aldeen, Blandine Rammaert, Maria Gamaletsou, Nikolaos V Sipsas, Valerie Zeller, Emmanuel Roilides, Dimitrios P Kontoyiannis, Andy O Miller, Vidmantas Petraitis, Thomas J Walsh, Olivier Lortholary
Osteoarticular mycoses due to non-Aspergillus moulds are uncommon and challenging infections. A systematic literature review of non-Aspergillus osteoarticular mycoses was performed using PUBMED and EMBASE databases from 1970 to 2013. Among 145 patients were 111 adults (median age 48.5 [16-92 y]) and 34 pediatric patients (median age 7.5 [3-15 y]); 114 (79.7%) were male and 88 (61.9%) were immunocompromised. Osteomyelitis was due to direct inoculation in 54.5%. Trauma and puncture wounds were more frequent in children (73...
December 2015: Medicine (Baltimore)
Ryoji Kobayashi, Hirozumi Sano, Kenji Kishimoto, Daisuke Suzuki, Kazue Yasuda, Kunihiko Kobayashi
We report analysis of voriconazole (VRCZ) concentration of cerebrospinal fluid (CSF) during prophylactic use in children and adolescents with acute myelogenous leukemia. The median CSF/plasma ratio was 0.57 (range, 0.35-1.04). There was a significant positive correlation between the VRCZ concentrations in CSF and plasma. The CSF/blood ratio negatively correlated with age, body weight and VRCZ concentration in plasma and CSF. VRCZ is more highly transferred to CSF at low plasma concentrations, and the rate is lower at high plasma concentrations...
March 2016: Pediatric Infectious Disease Journal
Hyun Mi Kang, Hoan Jong Lee, Eun Young Cho, Kyung-Sang Yu, Hyunju Lee, Ji Won Lee, Hyoung Jin Kang, Kyung Duk Park, Hee Young Shin, Eun Hwa Choi
Voriconazole is an antifungal drug used to treat fungal infections. This was a retrospective study of 61 children with hemato-oncologic diseases or solid organ transplantation who were administered voriconazole for invasive fungal infections. Of the 61 patients, 31 (50.8%) were in the therapeutic drug monitoring (TDM) group, and 30 (49.2%) were in the non-TDM group. At 12 weeks, treatment failure rate in the non-TDM group was higher than the TDM group (78.6% versus 40.0%, p = 0.038). Drug discontinuation due to adverse events was less frequent in the TDM group than the non-TDM group (26...
2015: Pediatric Hematology and Oncology
Karin Kato, Miki Nagao, Masaki Yamamoto, Yasufumi Matsumura, Shunji Takakura, Kazuhiko Fukuda, Satoshi Ichiyama
Voriconazole is used for treating or preventing invasive aspergillosis and other invasive fungal infections. To minimize adverse reactions and to maximize treatment effects, therapeutic drug monitoring should be performed. However, it is challenging to optimize daily voriconazole dosing because limited data have been published so far on pediatric patients. We retrospectively analyzed voriconazole concentrations in patients aged 0-18 years. In addition, a literature review was conducted. In our study cohort, younger age and oral administration were significantly associated with lower plasma voriconazole concentrations (P < 0...
January 2016: Journal of Infection and Chemotherapy: Official Journal of the Japan Society of Chemotherapy
Sonia M Restrepo-Gualteros, Lina E Jaramillo-Barberi, Carlos E Rodríguez-Martínez, Germán Camacho-Moreno, Gustavo Niño
The fungus Aspergillus spp. causes infections in immunocompromised hosts and produces a variety of clinical syndromes including lung tracheobronchial, chronic necrotizing pulmonary and allergic bronchopulmonary manifestations, as well as aspergilloma, depending on the type of host-fungus relationship involved. Aspergilloma is usually colonized by Aspergillus spp. lesions in the bronchial tree, while invasive forms are characterized by the presence of hyphae below its basement membrane. The objective of the present study was to describe the case of a pediatric patient with invasive pulmonary aspergillosis in the form of pseudomembranous tracheobronchitis, including the clinical course, diagnostic approach and paraclinical care provided...
April 2015: Biomédica: Revista del Instituto Nacional de Salud
Hasan Khosravi, Birgitta Schmidt, Jennifer T Huang
BACKGROUND: Pediatric and young adult nonmelanoma skin cancer (NMSC) is rare and traditionally associated with predisposing heritable or congenital conditions. Clinical characteristics, outcomes, and iatrogenic risk factors have not been well described. OBJECTIVES: We sought to characterize clinical features, potential risk factors, and gaps in care associated with NMSC in children and young adults. METHODS: This was a retrospective chart review of children and young adults with squamous and basal cell carcinoma...
November 2015: Journal of the American Academy of Dermatology
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