Voriconazole therapy in children with cystic fibrosis

Voriconazole therapy in children with cystic fibrosis,Tom Hilliard,Sian Edwards,Roger Buchdahl,Jacqueline Francis,Mark Rosenthal,Ian Balfour-Lynn,Andr

Voriconazole therapy in children with cystic fibrosis   (Citations: 20)
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Background: There is increasing evidence for the efficacy of the antifungal voriconazole, particularly in immunosuppression. We describe our experience of using voriconazole in children with CF. Methods: We performed a retrospective case note review of children with CF treated with voriconazole in a single centre over an 18 month period. Results: A total of 21 children aged 5 to 16 years (median 11.3) received voriconazole for between 1 and 50 (22) weeks. Voriconazole was used as monotherapy in 2 children with recurrent allergic bronchopulmonary aspergillosis (ABPA); significant and sustained improvements in clinical and serological parameters for up to 13 months were observed, without recourse to oral steroids. Voriconazole was used in combination with an immunomodulatory agent in a further 11 children with ABPA, with significant improvement in pulmonary function and serology. 8 children without ABPA but who had recurrent Aspergillus fumigatus isolates and increased symptoms also received voriconazole; this group did not improve with treatment. Adverse effects occurred in 7 children (33%: photosensitivity reaction 3, nausea 2, rise in hepatic enzymes 1, hair loss 1). Conclusions: Voriconazole may be a useful adjunctive therapy for ABPA in CF. Voriconazole monotherapy appears to be an alternative treatment strategy when oral corticosteroids may not be suitable.
Published in 2005.
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    • ...Hilliard et al. [48] reported a retrospective case series of 13 children with CF and ABPA treated with another triazole antifungal, voriconazole; this included two patients treated without oral steroids with improvement up to 13 months...

    Richard B. Moss. Management of allergic aspergillosis

    • ...budesonide, fluticasone, mometasone, ciclesonide) in modest dose and without spacers [18]...
    • ...New azoles with activity against Aspergillus including voriconazole have also been used with some success, but also signficiant adverse effects in some patients [40]...
    • ...In addition, both itraconazole and voriconazole have been used in some ABPA patients with CF as monotherapy, with mixed results [36,37,40]...

    Richard B. Moss. Critique of trials in allergic bronchopulmonary aspergillosis and fung...

    • ...These drugs are promising new agents for the eradication of Aspergillus species from the airways, though there is little experience with these drugs in patients with ABPA thus far [31]...

    Marc A. Judson. The Treatment of ABPA

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