Introduction
Although many and novel antifungal agents are in use, invasive fungal
infections (IFI) continue to cause high morbidity and mortality rates in
pediatric hematologic malignancy patients.1,2Successful treatment of IFI is required to ensure the survival of this
population. Currently, there are four classes (azoles, polyenes,
pyrimidine analogues, and echinocandins) of drugs used in the treatment
of IFI in children.3 Appropriate use of existing
antifungals in this vulnerable population is important for the treatment
of IFI.2 However, safety and efficacy data including
antifungal activity, pharmacokinetic properties, and toxicity of the
antifungal agents in children still needs to be supported by
trials.3,4 Monotherapy is often preferred for the
treatment of fungal infections in pediatric patients.4In some serious fungal infections where monotherapy is insufficient, the
combination of antifungals remains on the agenda as a potential
treatment strategy.5 Because serious fungal infections
need to be cured during the treatment of primary diseases, children with
hematologic malignancies are the group of patients in whom combination
regimens are frequently considered and tried to be
applied.4,5
Antifungal combination therapies are used in hematologic malignancy
patients considering potential gains such as preventing resistance
problems, increasing treatment efficacy and reducing side
effects.5,6 Combined antifungal therapy (CAT) is not a
new notion, it is even used effectively in the treatment of some
well-defined infections.7 Unfortunately, the role of
combination regimens in the treatment of IFI in patients with
hematologic malignancies remains controversial.8Despite insufficient evidence, there are pre-clinical studies indicating
that combination regimens are effective in fungal infections difficult
to treat.9-11 However, these studies could not be
transferred to the clinical practice, and quite few data are available
for clinical use. The limited data on this treatment prescription, with
almost no prospective studies and more limited data in pediatric
patients, are obtained as a result of clinical
experience.6,8,12-15 The combinations of four groups
of antifugal agents, acting through different molecular pathways and
different cellular targets, is shaped to the preference and priority of
clinicians as there is no definitive accepted
recommendation.8,9 In the absence of sufficient
evidence and suggestions; this study was aimed to demostrate experience
data on the use of CAT in pediatric patients with haematological
malignancies with IFI, including the results of efficacy and toxicity.