Posaconazole in immunocompromised pediatric patients
Posaconazole in immunocompromised pediatric patients
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DOI：
10.1080/14787210.2018.1490177
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发表时间：
2018-01-01
影响因子：
5.7
通讯作者：
Cesaro, Simone
中科院分区：
文献类型：
--
作者：
Vicenzi, Edoardo Bruno;Cesaro, Simone
泊沙康唑是一种广谱三唑类药物，广泛用于预防和治疗成人侵袭性真菌病。自从十多年前获得上市许可以来，许多作者报道了其在儿科患者中的超说明书使用，尽管尚未对儿童的药代动力学，安全性和疗效进行广泛研究。我们回顾了2010年至2017年间发表的描述泊沙康唑预防和治疗用途的儿科研究，特别注意口服剂量、血浆水平、安全性和有效性之间的相关性。我们发现泊沙康唑在儿童中耐受性良好，不良反应发生率低。在成人中，泊沙康唑的吸收受到胃内pH值高、粘膜炎和合并用药等因素的阻碍，而由于饱和吸收，每日剂量和血浆谷浓度之间没有直接相关性：泊沙康唑已被证明在预防和治疗免疫功能低下儿童真菌感染方面安全有效。建议采用基于体重的给药方案和治疗药物监测，以优化泊沙康唑血药浓度。吸收可以通过高脂肪食物或避免使用质子泵抑制剂来改善。需要进一步的儿科研究，特别是泊沙康唑的新制剂（小瓶和片剂）。
Introduction: Posaconazole is a broad-spectrum triazole widely used to prevent and treat invasive mycoses in adults. Since it received marketing authorization more than a decade ago, many authors have reported on its off-label use in pediatric patients, despite the fact that the pharmacokinetics, safety, and efficacy in children have not been extensively investigated.Areas covered: We reviewed pediatric studies published between 2010 and 2017 describing the prophylactic and therapeutic use of posaconazole, with special attention to the correlation between oral dose, plasma levels, safety, and effectiveness. We found that posaconazole is well tolerated in children with a low incidence of adverse effects. As in adults, posaconazole absorption is hampered by factors such as high gastric pH, mucositis, and concomitant medications, whereas there is no direct correlation between the daily dose and the trough plasma concentration due to saturable absorption.Expert Commentary: Posaconazole has proved safe and effective in preventing and treating fungal infections in immunocompromised children. A body-weight-based dosing regimen and therapeutic drug monitoring are recommended to optimize posaconazole plasma concentration. Absorption can be improved by high-fat foods or avoiding the use of proton-pump inhibitors. Further pediatric studies are needed especially for the new formulations of posaconazole (vials and tablets).