Voriconazole pharmacokinetics and photosensitivity in children with cystic fibrosis

Markantonis, Sophia L.; Katelari, A.; Pappa, Eleni; Doudounakis, Stavros

doi:10.1016/j.jcf.2011.12.006

Cited by 25 publications

(22 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Newer oral triazoles with excellent anti-Aspergillus activity (voriconazole and posaconazole) have also been reported as beneficial in the treatment of ABPA, particularly in patients with CF [48,49,[89][90][91]. In one study, voriconazole was used as monotherapy in 13 CF patients with ABPA; significant and sustained improvements in clinical status, lung function and serologies occurred with prolonged treatment, although nine patients required oral steroids [48].…”

Section: Antifungal Therapy In Abpa and Safsmentioning

confidence: 99%

“…This complex metabolism results in much greater inter-individual variability in steady-state voriconazole levels when compared with itraconazole (up to 100-fold range for voriconazole versus 15-fold range for itraconazole), making therapeutic drug monitoring highly advisable [73,92,93]. In addition, there appears to be both greater incidence and severity of toxicities with voriconazole when compared with itraconazole [91,94]. Voriconazole levels of .6 mg?mL -1 are predictive of increased toxicity, including: hepatic; ophthalmological and photosensitive dermatological adverse reactions; and rare, but more serious, cardiac (Torsades de pointes) and neurological events.…”

Section: Antifungal Therapy In Abpa and Safsmentioning

confidence: 99%

See 1 more Smart Citation

Treatment options in severe fungal asthma and allergic bronchopulmonary aspergillosis

Moss

2013

European Respiratory Journal

View full text Add to dashboard Cite

Severe asthma with fungal sensitisation and allergic bronchopulmonary aspergillosis encompass two closely related subgroups of patients with severe allergic asthma. Pulmonary disease is due to pronounced host inflammatory responses to noninvasive subclinical endobronchial infection with filamentous fungi, usually Aspergillus fumigatus. These patients usually do not achieve satisfactory disease control with conventional treatment of severe asthma, i.e. high-dose inhaled corticosteroids and long-acting bronchodilators. Although prolonged systemic corticosteroids are effective, they carry a substantial toxicity profile. Supplementary or alternative therapies have primarily focused on use of antifungal agents including oral triazoles and inhaled amphotericin B. Immunomodulation with omalizumab, a humanised anti-IgE monoclonal antibody, or "pulse" monthly high-dose intravenous corticosteroid, has also been employed. This article considers the experience with these approaches, with emphasis on recent clinical trials. @ERSpublications Treatment of fungal asthma includes glucocorticoids, azoles, amphotericin and anti-IgE. Trial validation is needed.

show abstract

Section: Antifungal Therapy In Abpa and Safsmentioning

confidence: 99%

Section: Antifungal Therapy In Abpa and Safsmentioning

confidence: 99%

Treatment options in severe fungal asthma and allergic bronchopulmonary aspergillosis

Moss

2013

European Respiratory Journal

View full text Add to dashboard Cite

show abstract

“…In the Briefing Document to the Food and Drug Administration, photosensitivity reaction was noted in only 41 of 2,090 (2%) patients receiving voriconazole. Isolated cases and case series have reported acute phototoxicity and photoaging in BMT and other immunosuppressed patient populations [1][2][3]7,8]. While the initial voriconazole trials enrolled hospitalized patients, most of the patients in recent reports, including ours, were in outpatient Pediatr Blood Cancer DOI 10.1002/pbc settings with greater opportunity for sun exposure.…”

Section: Discussionmentioning

confidence: 85%

Phototoxic dermatoses in pediatric BMT patients receiving voriconazole

Goyal

Gehris

Howrie

et al. 2014

Pediatric Blood & Cancer

View full text Add to dashboard Cite

We investigated the incidence of phototoxic skin reactions in pediatric BMT recipients treated with voriconazole. Nine out of 40 patients (22.5%), all Caucasian, developed skin lesions in sun-exposed distributions. Dermatologic findings included sunburn-like erythema, pseudo-porphyria, linear papulovesicular lesions, severe erosive cheilitis, dermatoheliosis and lentigines. Patients were treated with sun avoidance, high-potency sunscreens, and topical steroids with significant improvement in all cases. Prolonged voriconazole use requires close monitoring for chronic skin toxicities. Long-term risks including the risk of skin cancer need to be investigated.

show abstract

“…She received oral voriconazole (200 mg twice daily) for 6 months and her pulmonary function was improved progressively. During this period culture results were negative for fungi (Tables ) …”

Section: Resultsmentioning

confidence: 99%

Scedosporium apiospermum complex in cystic fibrosis; should we treat?

Noni

Katelari

Kapi

et al. 2017

Mycoses

Self Cite

View full text Add to dashboard Cite

Species of the Scedosporium apiospermum complex are the second most frequent filamentous fungi after Aspergillus fumigatus that can be found in cystic fibrosis (CF). Mixed colonisation by S. apiospermum complex and A. fumigatus is also quite common. In this study we summarise all CF patients who were colonised by S. apiospermum complex during their childhood and we present two CF patients who were treated as fungal bronchitis due to S. apiospermum complex. The medical records of 400 CF patients were reviewed in order to identify those with positive respiratory cultures for S. apiospermum complex. Scedosporium apiospermum complex was isolated in 10 CF patients and six of them had more than two positive sputum cultures during the study period. By the time of first isolation, the median age was 14.5 years, the median BMI was 19.41 kg/m , the median predicted FEV % was 78.65% and six patients had a history of A. fumigatus isolation. Two patients presented symptoms of infection while they were colonised by S. apiospermum complex. A rapid remission of their symptoms was observed only when antifungal therapy was administered. Antifungal treatment should be considered in CF patients who present symptoms of infection not responding to antibacterial therapy and S. apiospermum complex is persistently growing in sputum cultures.

show abstract

Voriconazole pharmacokinetics and photosensitivity in children with cystic fibrosis

Cited by 25 publications

References 24 publications

Treatment options in severe fungal asthma and allergic bronchopulmonary aspergillosis

Treatment options in severe fungal asthma and allergic bronchopulmonary aspergillosis

Phototoxic dermatoses in pediatric BMT patients receiving voriconazole

Scedosporium apiospermum complex in cystic fibrosis; should we treat?

Contact Info

Product

Resources

About