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Article

Efficacy and Safety Assessment of Antifungal Prophylaxis with Posaconazole Using Therapeutic Drug Monitoring in Pediatric Patients with Oncohematological Disorders—A Single-Centre Study

by
Karolina Liszka
1,*,
Paweł Marschollek
1,
Dawid Przystupski
1,
Jowita Frączkiewicz
1,
Monika Mielcarek-Siedziuk
1,
Igor Olejnik
1,
Zuzanna Gamrot
1,
Natalia Haze
1,
Agnieszka Kwella
1,
Paulina Zalewska
2,
Matylda Resztak
3,
Marek Ussowicz
1 and
Krzysztof Kałwak
1
1
Department of Pediatric Bone Marrow Transplantation, Oncology and Hematology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
2
MonitLab Laboratory, 61-612 Poznan, Poland
3
Department of Physical Pharmacy and Pharmacokinetics, Poznan University of Medical Sciences, Rokietnicka 3, 60-806 Poznań, Poland
*
Author to whom correspondence should be addressed.
J. Fungi 2025, 11(1), 38; https://doi.org/10.3390/jof11010038
Submission received: 14 November 2024 / Revised: 20 December 2024 / Accepted: 23 December 2024 / Published: 6 January 2025
(This article belongs to the Special Issue Advances in Antifungal Drugs, 2nd Edition)
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Abstract

Introduction: Posaconazole is recommended for prophylaxis in pediatric immunocompromised patients. Due to its variability in bioavailability and drug-to-drug interactions, EBMT recommends regimens based on therapeutic drug monitoring (TDM). Materials and methods: In total, 171 oncohematological pediatric patients on posaconazole prophylaxis were included. Full pharmacokinetic posaconazole profiles were assessed in 51 children. The efficacy and safety of posaconazole was evaluated by measuring the drug concentration, with dose modification attempted in patients with suboptimal results. The influence of modifying factors on the posaconazole plasma concentration (PPC) was investigated. Results: An insufficient PPC was the main issue, but no significant increase in prophylaxis failure was reported. The modification of the dosage resulted in the optimization of PPC in 50% of patients. No significant correlation between age, gender, diagnosis or the posaconazole dosage and the PPC was found. HCT, total parenteral nutrition and diarrhea were associated with a lower PPC. Hypoalbuminemia was related to both higher and lower PPC. The concomitant administration of specified drugs significantly impacted the PPC. Conclusions: TDM allows the identification of patients receiving non-optimal treatment and offers an opportunity to improve the efficacy and safety of the therapy. However, further research involving larger patient groups and longer observation periods are needed to determine the optimal dosing and target PPC in pediatric patients.
Keywords: posaconazole; therapeutic drug monitoring (TDM); antifungal prophylaxis posaconazole; therapeutic drug monitoring (TDM); antifungal prophylaxis

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MDPI and ACS Style

Liszka, K.; Marschollek, P.; Przystupski, D.; Frączkiewicz, J.; Mielcarek-Siedziuk, M.; Olejnik, I.; Gamrot, Z.; Haze, N.; Kwella, A.; Zalewska, P.; et al. Efficacy and Safety Assessment of Antifungal Prophylaxis with Posaconazole Using Therapeutic Drug Monitoring in Pediatric Patients with Oncohematological Disorders—A Single-Centre Study. J. Fungi 2025, 11, 38. https://doi.org/10.3390/jof11010038

AMA Style

Liszka K, Marschollek P, Przystupski D, Frączkiewicz J, Mielcarek-Siedziuk M, Olejnik I, Gamrot Z, Haze N, Kwella A, Zalewska P, et al. Efficacy and Safety Assessment of Antifungal Prophylaxis with Posaconazole Using Therapeutic Drug Monitoring in Pediatric Patients with Oncohematological Disorders—A Single-Centre Study. Journal of Fungi. 2025; 11(1):38. https://doi.org/10.3390/jof11010038

Chicago/Turabian Style

Liszka, Karolina, Paweł Marschollek, Dawid Przystupski, Jowita Frączkiewicz, Monika Mielcarek-Siedziuk, Igor Olejnik, Zuzanna Gamrot, Natalia Haze, Agnieszka Kwella, Paulina Zalewska, and et al. 2025. "Efficacy and Safety Assessment of Antifungal Prophylaxis with Posaconazole Using Therapeutic Drug Monitoring in Pediatric Patients with Oncohematological Disorders—A Single-Centre Study" Journal of Fungi 11, no. 1: 38. https://doi.org/10.3390/jof11010038

APA Style

Liszka, K., Marschollek, P., Przystupski, D., Frączkiewicz, J., Mielcarek-Siedziuk, M., Olejnik, I., Gamrot, Z., Haze, N., Kwella, A., Zalewska, P., Resztak, M., Ussowicz, M., & Kałwak, K. (2025). Efficacy and Safety Assessment of Antifungal Prophylaxis with Posaconazole Using Therapeutic Drug Monitoring in Pediatric Patients with Oncohematological Disorders—A Single-Centre Study. Journal of Fungi, 11(1), 38. https://doi.org/10.3390/jof11010038

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