Fluconazole to voriconazole:
The two children that switched from fluconazole to voriconazole did so for the treatment of a possible mold infection in the setting of febrile neutropenia (Table 1). One child (Case 4) was post-HSCT with concurrent GVHD (grade 1 skin and upper gastrointestinal disease). The GGT peaked 3 days after the switch to voriconazole (333 IU/L, 8.3 x ULN) and normalised by the end of the 55-day treatment course. Causality was assessed as ‘possible’ (Naranjo score 4) as the child was not subsequently rechallenged with fluconazole. The second child (Case 5, Table 1) was prescribed fluconazole after initial switch to voriconazole and the GGT derangement continued to improve despite this rechallenge. The case was also assessed as ‘possible’ (Naranjo score 2).