Pediatric Hematology Department, Ege University School of Medicine, Izmir, Turkey.
Mycoses. 2011 May;54(3):234-42. doi: 10.1111/j.1439-0507.2009.01808.x.
Combination treatment of paediatric invasive fungal infections (IFIs) has rarely been reported. A total of 17 children with 19 IFI episodes were enrolled in the study. The median age of the patients was 5.3 (range 0.5-17) years. IFI was classified as proven in 4, probable in 12 and possible in 3 episodes. These patients received empiric antifungal treatment, which consisted of liposomal amphotericin B (LAmB) monotherapy for a median duration of 12 days (range 3-69 days). All patients were refractory to LAmB; therefore, caspofungin was added to the therapy in 11 patients. In the remaining six patients, LAmB was ceased and a combination of caspofungin and voriconazole was started. Among the patients who received caspofungin + LAmB, four did not show favourable response and the combination was switched to caspofungin + voriconazole. The median (range) and total duration of the therapy were 7 (3-14) days and 91 patient days for LAmB + caspofungin combination and 49 (7-126) days and 516 patient days for caspofungin + voriconazole combination. We found a favourable response rate of 68.4% in 16 proven or probable IFI episodes. Twelve-week survival rate of these patients was 75%. No serious side effect was observed among the patients. Our data suggest that combination antifungal therapy is safe and effective in children with haematological malignancies.
儿童侵袭性真菌感染（IFI）的联合治疗鲜有报道。本研究共纳入 17 例 19 次 IFI 患儿。患儿中位年龄为 5.3（0.5-17）岁。IFI 确诊 4 例，临床诊断 12 例，拟诊 3 例。这些患儿接受经验性抗真菌治疗，包括脂质体两性霉素 B（LAmB）单药治疗，中位疗程 12 天（3-69 天）。所有患儿均对 LAmB 耐药，因此 11 例患儿加用卡泊芬净。另外 6 例患儿停用 LAmB，改用卡泊芬净联合伏立康唑。在接受卡泊芬净+LAmB 治疗的患儿中，4 例未获得良好反应，将联合方案换为卡泊芬净+伏立康唑。LAmB+卡泊芬净组的中位（范围）及总疗程分别为 7（3-14）天和 91 个患儿日，卡泊芬净+伏立康唑组分别为 49（7-126）天和 516 个患儿日。我们发现 16 例确诊或临床诊断 IFI 患儿的有效率为 68.4%。这些患儿的 12 周存活率为 75%。患儿均未出现严重不良反应。我们的数据表明，联合抗真菌治疗在血液恶性肿瘤患儿中是安全有效的。
