Antifungal combination therapy for invasive fungal infections in a paediatric oncology and haematology department: A retrospective analysis of practice

Lignieres, Gabriel; Guitard, Juliette; Alby-Laurent, Fanny; Rambaud, Jérôme; Bigot, J. M.; Morand, Karine; Leverger, Guy; Tabone, Marie‐Dominique

doi:10.1016/j.mycmed.2022.101276

Cited by 5 publications

(3 citation statements)

References 22 publications

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“…Current literature that describes combination use for treatment of invasive infections shows mixed efficacy results and increased toxicities when combining agents, particularly voriconazole and amphotericin B. [27][28][29][30] Lack of therapeutic voriconazole concentrations prompted use of dual therapy in several instances in our study, demonstrating this additional indication for combination use and need to obtain therapeutic concentrations in a timelier fashion.…”

Section: Discussionmentioning

confidence: 70%

Evaluation of Empiric Voriconazole Dosing and Therapeutic Drug Monitoring in Hospitalized Pediatric Patients

Schweiger,

Heiden,

MacBrayne

2024

Journal of Pediatric Hematology/Oncology

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Summary: Invasive fungal infections are a significant cause of morbidity and mortality in children with immunodeficiencies. Current dosing recommendations for voriconazole often result in subtherapeutic exposure in pediatric patients. In this single-center retrospective study, we reviewed hospitalized pediatric patients receiving voriconazole with at least one inpatient serum trough concentration measured. Patient characteristics and voriconazole dosing courses with associated trough concentrations were summarized for all patients as well as grouped by age (0 to 1 y, 2 to 11 y, and 12 to 18 y). Of 106 included patients, the median age was 9 years (range, 29 d to 18 y). Five hundred ninety courses of voriconazole were administered with 365 associated troughs. Most troughs were subtherapeutic (49%) and 30% of patients never attained a therapeutic trough. The median oral daily dose associated with a therapeutic trough was higher in younger age groups: 21.6 mg/kg 0 to 1 year, 17.9 mg/kg 2 to 11, and 9.5 mg/kg 12 to 18 years (P<0.001). Patients younger than 2 years had the largest proportion of subtherapeutic troughs and variability in dosing. Attainment of therapeutic voriconazole concentrations was challenging across all pediatric age groups. Higher starting doses for patients younger than 2 years are likely needed.

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Section: Discussionmentioning

confidence: 70%

Evaluation of Empiric Voriconazole Dosing and Therapeutic Drug Monitoring in Hospitalized Pediatric Patients

Schweiger,

Heiden,

MacBrayne

2024

Journal of Pediatric Hematology/Oncology

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“…With the emergence of new strains of resistant fungi, it is crucial to persist in investigating and developing fresh drug combinations that effectively combat these pathogens, thereby reducing the likelihood of resistance development [ 79 ]. This approach holds particular significance in the treatment of chronic or recurrent fungal infections, where the emergence of resistance is a notable concern [ 80 ]. One avenue for advancing combination antifungal therapy involves merging natural products and synthetic drugs [ 81 ].…”

Section: Future Perspectivesmentioning

confidence: 99%

Cyclic Peptides with Antifungal Properties Derived from Bacteria, Fungi, Plants, and Synthetic Sources

Helmy

Parang

2023

Pharmaceuticals

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Fungal infections remain a significant concern for human health. The emergence of microbial resistance, the improper use of antimicrobial drugs, and the need for fewer toxic antifungal treatments in immunocompromised patients have sparked substantial interest in antifungal research. Cyclic peptides, classified as antifungal peptides, have been in development as potential antifungal agents since 1948. In recent years, there has been growing attention from the scientific community to explore cyclic peptides as a promising strategy for combating antifungal infections caused by pathogenic fungi. The identification of antifungal cyclic peptides from various sources has been possible due to the widespread interest in peptide research in recent decades. It is increasingly important to evaluate narrow- to broad-spectrum antifungal activity and the mode of action of synthetic and natural cyclic peptides for both synthesized and extracted peptides. This short review aims to highlight some of the antifungal cyclic peptides isolated from bacteria, fungi, and plants. This brief review is not intended to present an exhaustive catalog of all known antifungal cyclic peptides but rather seeks to showcase selected cyclic peptides with antifungal properties that have been isolated from bacteria, fungi, plants, and synthetic sources. The addition of commercially available cyclic antifungal peptides serves to corroborate the notion that cyclic peptides can serve as a valuable source for the development of antifungal drugs. Additionally, this review discusses the potential future of utilizing combinations of antifungal peptides from different sources. The review underscores the need for the further exploration of the novel antifungal therapeutic applications of these abundant and diverse cyclic peptides.

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“…With the emergence of new strains of resistant fungi, it is crucial to persist in investigating and developing fresh drug combinations that effectively combat these pathogens, thereby reducing the likelihood of resistance development [78]. This approach holds particular significance in the treatment of chronic or recurrent fungal infections, where the emergence of resistance is a notable concern [79]. One avenue for advancing combination antifungal therapy involves merging natural products and synthetic drugs [80].…”

Section: Future Perspectivesmentioning

confidence: 99%

Cyclic Peptides with Antifungal Properties Derived from Bacteria, Fungi, Natural Products, and Synthetic Sources

Helmy¹,

Parang²

2023

Preprint

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Fungal infections pose a significant threat to human health, particularly in immunocompromised individuals. Due to several factors, such as the inappropriate use of antimicrobial drugs, the emergence of resistance in microorganisms, and increasing demand for less cytotoxic antifungal agents for immunocompromised patients, antifungal research has gained significant attention in recent years. Antifungal peptides, and among them, cyclic peptides, are a class of antifungal agents that have been under development since the 1960s. Using cyclic peptides as a promising approach for combating antifungal resistance in pathogenic fungi has gained significant attention in recent years. The identification of antifungal cyclic peptides from various sources has been possible due to the widespread interest in peptide research in recent decades. It is increasingly important to evaluate the narrow to broad-spectrum antifungal activity and the mode of action of synthetic and natural cyclic peptides for both synthesized and extracted peptides. This short review aims to highlight some of the antifungal cyclic peptides isolated from bacteria, fungi, and plants, taking into consideration the progress made in peptide research. Additionally, it provides a summary of synthetic cyclic peptides with antifungal activity and discusses the potential future of utilizing combinations of antifungal peptides from different sources. The review underscores the need for further exploration of the novel therapeutic applications of these abundant and diverse cyclic peptides.

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Antifungal combination therapy for invasive fungal infections in a paediatric oncology and haematology department: A retrospective analysis of practice

Cited by 5 publications

References 22 publications

Evaluation of Empiric Voriconazole Dosing and Therapeutic Drug Monitoring in Hospitalized Pediatric Patients

Evaluation of Empiric Voriconazole Dosing and Therapeutic Drug Monitoring in Hospitalized Pediatric Patients

Cyclic Peptides with Antifungal Properties Derived from Bacteria, Fungi, Plants, and Synthetic Sources

Cyclic Peptides with Antifungal Properties Derived from Bacteria, Fungi, Natural Products, and Synthetic Sources

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