Efficacy of liposomal amphotericin against febrile neutropenia in pediatric patients receiving prophylactic voriconazole

Pediatr Int. 2020 Aug 31. doi: 10.1111/ped.14450. Online ahead of print.


BACKGROUND: The risk factors for invasive fungal infection (IFI) have gradually become evident for pediatric patients with hematological diseases. Here we analyzed the efficacy of liposomal amphotericin (L-AMB) for pediatric patients with febrile neutropenia using prophylactic voriconazole (VRCZ).

METHOD: We administered L-AMB (2.5mg/kg/day) in patients with febrile neutropenia who were receiving prophylactic VRCZ (10mg/kg/day, orally) and were resistant to second line antibiotics therapy. Thirteen patients (5 males, 8 females) with 19 febrile neutropenia episodes were targeted in this analysis. The median age of the patients was 14 years (range, 1-19 years). Eighteen out of 19 episodes occurred in patients with acute myeloid leukemia (AML), with the remaining episode occurring in a patient with acute unclassified leukemia.

RESULTS: The median period from start of L-AMB administration to resolution of fever was 4 days (1-27 days). In 15 out of 19 episodes, fever resolved within five days from commencement of L-AMB administration. Using criteria proposed by Walsh TJ, et al., the success rate of L-AMB for febrile neutropenia was 89.5% in this study.

CONCLUSION: Although the sample size of our study was small, the extremely high efficacy of L-AMB warrants its administration in patients with febrile neutropenia who are receiving VRCZ.

PMID:32869416 | DOI:10.1111/ped.14450