2021 Volume 58 Issue 5 Pages 414-418
Invasive fungal infection in pediatric patients with leukemia or malignant tumors is intractable and has a poor prognosis in many cases. Delayed diagnosis and treatment may also affect the prognosis. However, an early definite diagnosis is difficult in many patients; thus, it is important to make an early diagnosis using appropriate auxiliary methods. It is also important to prevent infection during treatment of acute leukemia or after hematopoietic stem cell transplantation, in which the risk of infection is high. In the treatment and prophylaxis of infection, an appropriate antifungal drug needs to be selected depending on the type of fungus. Since pediatric patients have more rapid hepatic metabolism than adult patients, the optimum dosage of a triazole antifungal agent per kg body weight is higher in children. When using these agents, careful attention should be paid to possible drug interactions related to cytochrome P450 (CYP) metabolism. In particular, triazole antifungal agents may inhibit the metabolism of cyclosporine and tacrolimus and thus increase the concentrations of these drugs in blood. The adverse effects of antineoplastic drugs, such as vincristine, cyclophosphamide, and gemtuzumab ozogamicin, may also be increased owing to the inhibition of their metabolism. Thus, if the administration of an antifungal agent is started or terminated, the effects on other drugs should be considered. Since voriconazole is affected by a genetic polymorphism in CYP2C19, which is related to its metabolism, monitoring is required by measuring its trough concentrations in blood.
