Insufficient fluconazole levels in pediatric patients with cancer treated for invasive candidiasis

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According to a new study published in the journal Clinical Infectious Diseases, researchers have found that the fluconazole concentration in pediatric patients with cancer and invasive candidiasis is not sufficient for treatment with the currently recommended dosing regimen.

For the study, researchers identified 99 critically ill pediatric patients treated with fluconazole from January 2007 to October 2013. Of the 99 patients, 40% had subtherapeutic fluconazole plasma concentrations. Analyses demonstrated a significant and positive association between fluconazole trough concentration and dose (P < 0.001), weight (P = 0.009) and the serum urea concentration (P = 0.003).

In addition, there was a significant and negative association between fluconazole trough concentration and age (P = 0.004) and cancer as the underlying cause of invasive candidiasis (P = 0.003). In addition, they found that a higher fluconazole trough concentration was linked with a decreased duration to culture conversion (HR = 1.076, 95% CI 1.017 - 1.138, P = 0.011).

The findings suggest that a higher dose of fluconazole is necessary to achieve sufficient drug concentrations for the treatment of invasive candidiasis in critically ill pediatric patients with cancer.

For pediatric patients with acute lymphoblastic leukemia (ALL), obesity increases risk of persistent
Fluconazole in pediatric patients with cancer and invasive candidiasis is not sufficient for treatment.
The study evaluate that fluconazole is recommended as first–line treatment in invasive candidiasis in children and infants. However, result suggest that the fluconazole concentration is not sufficient in pediatric cancer patients with the currently recommended dose regimen, and a higher fluconazole dose is required to achieve adequate drug exposure.
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