A Spanish paediatric case series, published in the Journal of Antimicrobial Chemotherapy, has demonstrated the safety and effectiveness of isavuconazole in treating invasive fungal disease (IFD) in children. Mendosa-Palomar et al. retrospectively analyzed 107 children (≤18 years) from nine public teaching hospitals in Spain, of whom isavuconazole was prescribed as treatment in 95 patients (89%) and as prophylaxis in 12 (11%). Microbiological diagnosis was available in 33% (31/95) of patients with Aspergillus species as the most isolated pathogen (16/31), followed by Mucorales (6/31).
A notable finding from this study was the use of isavuconazole primarily as a second-line treatment (64/95 patients, 67%), mainly due to toxicity from previous antifungals (27/64 patients, 42%) and therapeutic failure (24/64 patients, 37%). When prescribed as first-line treatment (31/95 patients, 34%), isavuconazole was mainly selected due to its favourable safety profile (18/31 patients, 58%) and less-variable pharmacokinetics (11/31 patients, 35%). Of 53 patients with proven/probable IFD, 32 (60%) showed a favourable response and 21 (40%) died, 13 of them due to IFD. Of the twelve patients who received isavuconazole as prophylaxis, none developed breakthrough IFD.
This study strongly affirms the safe and effective use of isavuconazole in the paediatric age group. In addition, given the number of cases where isavuconazole was used as second-line treatment and the high number of favourable outcomes, it wouldn’t be out of place to suggest its use as a first-line agent where available. However, therapeutic drug monitoring is strongly recommended as 59% of trough concentration values were outside the therapeutic range. Also, given that the median age of patients in this study was relatively high, there should be caution in extrapolation of findings to the younger age groups.
