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Posaconazole for Prophylaxis of Fungal Infection in Pediatric Patients with Acute Myeloid Leukemia undergoing Induction Chemotherapy
Korean J Clin Pharm 2018;28(3):181-187
Published online September 30, 2018
© 2018 Korean College of Clinical Pharmacy.

Seung Min Kim1, Yoon Sun Ree1, Jae Song Kim1, Soo Hyun Kim1, Eun Sun Son1*, and Chuhl Joo Lyu2

1Department of Pharmacy, Severance Hospital, Yon-sei University Health System, Seoul 03722, Republic of Korea
2Department of Pediatric Hematology Oncology, Severance Hospital, Yon-sei University Health System, Seoul 03722, Republic of Korea
Correspondence to: Eun Sun Son, Department of Pharmacy, Severance Hospital, Yon-sei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
Tel: +82-2-2228-4612, Fax: +82-2-2227-2983
E-mail: sespharm@yuhs.ac
Received February 20, 2018; Revised March 26, 2018; Accepted March 27, 2018.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: Posaconazole is a broad-spectrum triazole antifungal agent and the most recommended prophylactic antifungal agent for patients with acute myeloid leukemia (AML) undergoing induction chemotherapy. In this study, we evaluated the status and effectiveness of posaconazole as a prophylactic antifungal agent in pediatric patients receiving induction chemotherapy for AML.
Methods: We retrospectively reviewed the electronic medical records of 36 pediatric patients with AML (between January 2013 and September 2017) at the Yonsei University Health System. Invasive fungal disease (IFD) was assessed as the primary endpoint of prophylactic antifungal effect. The secondary endpoints were incidence of fever, persistent fever despite the use of broad-spectrum antibiotics for 72 h, alteration of antifungal agent, intensive care unit admission, and death within 100 days.
Results: Among the 36 patients, 18 patients used posaconazole, 12 were treated with suspension formula, and 6 of them were treated with tablets. Eighteen patients did not use antifungal agents prophylactically. The mean number of days of posaconazole administration was 26.8±16 days. IFD occurred in 2/18 (11.1%) patients in the no prophylaxis group and in 1/18 (5.6%) patients in the posaconazole group (p=0.49).
Conclusion: Posaconazole is expected to be useful for the prevention of IFD in pediatric patients with AML undergoing induction chemotherapy. Prospective studies of the effectiveness of posaconazole prophylaxis should be conducted in more pediatric patients in the future.
Keywords : Posaconazole, antifungal prophylaxis, pediatrics, acute myeloid leukemia


September 2018, 28 (3)
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