INTRODUCTION
The use of prophylactic antifungals has dramatically decreased the risk of the development of invasive fungal infections (IFIs) in cancer patients and patients undergoing hematopoietic stem cell transplantation (HSCT) being a major cause of morbidity and mortality (1,2).
Posaconazole is a triazole-extended spectrum used primarily for the prophylaxis and treatment of IFIs refractory to other antifungal therapies, due to its extensive coverage of yeast and filamentous fungi, and has shown to be effective in adolescents and adults (2-4). This drug is only approved for use in adults in Europe, and the oral suspension is approved by the Food and Drug Administration (FDA) only in individuals over 13 years of age (3,4). The recommendation for the use of posaconazole in children under 13 years of age is limited to individual cases as an ”off- label” prescription (5). Therefore, the use of posaconazole in prophylaxis (PP) in children has not been fully evaluated, and this is important since the underlying risk of drug toxicity and poor adherence to the drug could impact the failure of prophylaxis, increasing the risk of breakthrough fungal infection (3–5).Nonetheless, while the efficacy, safety, and pharmacokinetic characteristics of posaconazole as a prophylactic alternative have been evaluated in high-risk pediatric patients (6,7), it is only recommended for use in patients over the age of 13 years, unlike other antifungal drugs such as fluconazole, itraconazole, and voriconazole (6,7).
The aim of this study was to describe our experience with PP in children under 13 years of age with hematological diseases who had undergone HSCT at the Instituto Nacional de Salud del Niño San Borja (INSN-SB) in Lima, Peru.