Efficacy and Safety Assessment of Antifungal Prophylaxis with Posaconazole Using Therapeutic Drug Monitoring in Pediatric Patients with Oncohematological Disorders—A Single-Centre Study
Introduction: Posaconazole is recommended for prophylaxis in pediatric immunocompromised patients. Due to its variability in bioavailability and drug-to-drug interactions, EBMT recommends regimens based on therapeutic drug monitoring (TDM). Materials and methods: In total, 171 oncohematological pedi...
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2025-01-01
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| author | Karolina Liszka Paweł Marschollek Dawid Przystupski Jowita Frączkiewicz Monika Mielcarek-Siedziuk Igor Olejnik Zuzanna Gamrot Natalia Haze Agnieszka Kwella Paulina Zalewska Matylda Resztak Marek Ussowicz Krzysztof Kałwak |
| author_facet | Karolina Liszka Paweł Marschollek Dawid Przystupski Jowita Frączkiewicz Monika Mielcarek-Siedziuk Igor Olejnik Zuzanna Gamrot Natalia Haze Agnieszka Kwella Paulina Zalewska Matylda Resztak Marek Ussowicz Krzysztof Kałwak |
| author_sort | Karolina Liszka |
| collection | DOAJ |
| description | Introduction: Posaconazole is recommended for prophylaxis in pediatric immunocompromised patients. Due to its variability in bioavailability and drug-to-drug interactions, EBMT recommends regimens based on therapeutic drug monitoring (TDM). Materials and methods: In total, 171 oncohematological pediatric patients on posaconazole prophylaxis were included. Full pharmacokinetic posaconazole profiles were assessed in 51 children. The efficacy and safety of posaconazole was evaluated by measuring the drug concentration, with dose modification attempted in patients with suboptimal results. The influence of modifying factors on the posaconazole plasma concentration (PPC) was investigated. Results: An insufficient PPC was the main issue, but no significant increase in prophylaxis failure was reported. The modification of the dosage resulted in the optimization of PPC in 50% of patients. No significant correlation between age, gender, diagnosis or the posaconazole dosage and the PPC was found. HCT, total parenteral nutrition and diarrhea were associated with a lower PPC. Hypoalbuminemia was related to both higher and lower PPC. The concomitant administration of specified drugs significantly impacted the PPC. Conclusions: TDM allows the identification of patients receiving non-optimal treatment and offers an opportunity to improve the efficacy and safety of the therapy. However, further research involving larger patient groups and longer observation periods are needed to determine the optimal dosing and target PPC in pediatric patients. |
| format | Article |
| id | doaj-art-0b66d435d3c7450bb2a4161658518cc9 |
| institution | Kabale University |
| issn | 2309-608X |
| language | English |
| publishDate | 2025-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Fungi |
| spelling | doaj-art-0b66d435d3c7450bb2a4161658518cc92025-01-24T13:37:19ZengMDPI AGJournal of Fungi2309-608X2025-01-011113810.3390/jof11010038Efficacy and Safety Assessment of Antifungal Prophylaxis with Posaconazole Using Therapeutic Drug Monitoring in Pediatric Patients with Oncohematological Disorders—A Single-Centre StudyKarolina Liszka0Paweł Marschollek1Dawid Przystupski2Jowita Frączkiewicz3Monika Mielcarek-Siedziuk4Igor Olejnik5Zuzanna Gamrot6Natalia Haze7Agnieszka Kwella8Paulina Zalewska9Matylda Resztak10Marek Ussowicz11Krzysztof Kałwak12Department of Pediatric Bone Marrow Transplantation, Oncology and Hematology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, PolandDepartment of Pediatric Bone Marrow Transplantation, Oncology and Hematology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, PolandDepartment of Pediatric Bone Marrow Transplantation, Oncology and Hematology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, PolandDepartment of Pediatric Bone Marrow Transplantation, Oncology and Hematology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, PolandDepartment of Pediatric Bone Marrow Transplantation, Oncology and Hematology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, PolandDepartment of Pediatric Bone Marrow Transplantation, Oncology and Hematology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, PolandDepartment of Pediatric Bone Marrow Transplantation, Oncology and Hematology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, PolandDepartment of Pediatric Bone Marrow Transplantation, Oncology and Hematology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, PolandDepartment of Pediatric Bone Marrow Transplantation, Oncology and Hematology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, PolandMonitLab Laboratory, 61-612 Poznan, PolandDepartment of Physical Pharmacy and Pharmacokinetics, Poznan University of Medical Sciences, Rokietnicka 3, 60-806 Poznań, PolandDepartment of Pediatric Bone Marrow Transplantation, Oncology and Hematology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, PolandDepartment of Pediatric Bone Marrow Transplantation, Oncology and Hematology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, PolandIntroduction: Posaconazole is recommended for prophylaxis in pediatric immunocompromised patients. Due to its variability in bioavailability and drug-to-drug interactions, EBMT recommends regimens based on therapeutic drug monitoring (TDM). Materials and methods: In total, 171 oncohematological pediatric patients on posaconazole prophylaxis were included. Full pharmacokinetic posaconazole profiles were assessed in 51 children. The efficacy and safety of posaconazole was evaluated by measuring the drug concentration, with dose modification attempted in patients with suboptimal results. The influence of modifying factors on the posaconazole plasma concentration (PPC) was investigated. Results: An insufficient PPC was the main issue, but no significant increase in prophylaxis failure was reported. The modification of the dosage resulted in the optimization of PPC in 50% of patients. No significant correlation between age, gender, diagnosis or the posaconazole dosage and the PPC was found. HCT, total parenteral nutrition and diarrhea were associated with a lower PPC. Hypoalbuminemia was related to both higher and lower PPC. The concomitant administration of specified drugs significantly impacted the PPC. Conclusions: TDM allows the identification of patients receiving non-optimal treatment and offers an opportunity to improve the efficacy and safety of the therapy. However, further research involving larger patient groups and longer observation periods are needed to determine the optimal dosing and target PPC in pediatric patients.https://www.mdpi.com/2309-608X/11/1/38posaconazoletherapeutic drug monitoring (TDM)antifungal prophylaxis |
| spellingShingle | Karolina Liszka Paweł Marschollek Dawid Przystupski Jowita Frączkiewicz Monika Mielcarek-Siedziuk Igor Olejnik Zuzanna Gamrot Natalia Haze Agnieszka Kwella Paulina Zalewska Matylda Resztak Marek Ussowicz Krzysztof Kałwak Efficacy and Safety Assessment of Antifungal Prophylaxis with Posaconazole Using Therapeutic Drug Monitoring in Pediatric Patients with Oncohematological Disorders—A Single-Centre Study Journal of Fungi posaconazole therapeutic drug monitoring (TDM) antifungal prophylaxis |
| title | Efficacy and Safety Assessment of Antifungal Prophylaxis with Posaconazole Using Therapeutic Drug Monitoring in Pediatric Patients with Oncohematological Disorders—A Single-Centre Study |
| title_full | Efficacy and Safety Assessment of Antifungal Prophylaxis with Posaconazole Using Therapeutic Drug Monitoring in Pediatric Patients with Oncohematological Disorders—A Single-Centre Study |
| title_fullStr | Efficacy and Safety Assessment of Antifungal Prophylaxis with Posaconazole Using Therapeutic Drug Monitoring in Pediatric Patients with Oncohematological Disorders—A Single-Centre Study |
| title_full_unstemmed | Efficacy and Safety Assessment of Antifungal Prophylaxis with Posaconazole Using Therapeutic Drug Monitoring in Pediatric Patients with Oncohematological Disorders—A Single-Centre Study |
| title_short | Efficacy and Safety Assessment of Antifungal Prophylaxis with Posaconazole Using Therapeutic Drug Monitoring in Pediatric Patients with Oncohematological Disorders—A Single-Centre Study |
| title_sort | efficacy and safety assessment of antifungal prophylaxis with posaconazole using therapeutic drug monitoring in pediatric patients with oncohematological disorders a single centre study |
| topic | posaconazole therapeutic drug monitoring (TDM) antifungal prophylaxis |
| url | https://www.mdpi.com/2309-608X/11/1/38 |
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