Sienkiewicz-Oleszkiewicz Beata, Salamonowicz-Bodzioch Małgorzata, Słonka Justyna, Kałwak Krzysztof
Department of Clinical Pharmacology, Faculty of Pharmacy, Wrocław Medical University, ul. Borowska 211a, 50-556 Wrocław, Poland.
Department and Clinic of Pediatric Oncology, Hematology and Bone Marrow Transplantation, Wrocław Medical University, Borowska 213, 50-556 Wrocław, Poland.
J Clin Med. 2023 Jul 12;12(14):4637. doi: 10.3390/jcm12144637.
Leukemia is one of the leading childhood malignancies, with acute lymphoblastic leukemia (ALL) being the most common type. Invasive fungal disease is a concerning problem also at pediatric hemato-oncology units. Available guidelines underline the need for antifungal prophylaxis and give recommendations for proper treatment in various clinical scenarios. Nonetheless, antifungal agents are often involved in drug-drug interaction (DDI) occurrence. The prediction of those interactions in the pediatric population is complicated because of the physiological differences in adults, and the lack of pharmacological data. In this review, we discuss the potential DDIs between antifungal agents and commonly used pharmaceutics in pediatric hemato-oncology settings, with special emphasis on the use of liposomal amphotericin B and ALL treatment. We obtained information from Micromedex and Drugs.com interaction checking databases and checked the EudraVigilance database to source the frequency of severe adverse drug reactions that resulted from antifungal drug interactions. Several major DDIs were identified, showing a favorable safety profile of echinocandins and liposomal amphotericin B. Interestingly, although there are numerous available drug interaction checking tools facilitating the identification of potential serious DDIs, it is important to use more than one tool, as the presented searching results may differ between particular checking programs.
白血病是儿童期主要的恶性肿瘤之一，其中急性淋巴细胞白血病（ALL）最为常见。侵袭性真菌病在儿科血液肿瘤病房也是一个令人担忧的问题。现有指南强调了抗真菌预防的必要性，并针对各种临床情况给出了适当治疗的建议。尽管如此，抗真菌药物常常会引发药物相互作用（DDI）。由于儿童与成人在生理上存在差异，且缺乏药理学数据，因此预测儿科人群中的这些相互作用较为复杂。在本综述中，我们讨论了儿科血液肿瘤环境中抗真菌药物与常用药物之间潜在的药物相互作用，特别强调了脂质体两性霉素B的使用及ALL的治疗。我们从Micromedex和Drugs.com相互作用检查数据库获取信息，并查阅了欧洲药物警戒数据库，以获取抗真菌药物相互作用导致的严重药物不良反应的发生频率。我们识别出了几种主要的药物相互作用，结果显示棘白菌素类药物和脂质体两性霉素B具有良好的安全性。有趣的是，尽管有许多可用的药物相互作用检查工具有助于识别潜在的严重药物相互作用，但使用不止一种工具很重要，因为不同的检查程序给出的搜索结果可能会有所不同。
