scholarly journals Neurologic Adverse Events Associated with Voriconazole Therapy: Report of Two Pediatric Cases

2016 ◽  
Vol 2016 ◽  
pp. 1-3
Author(s):  
Sevliya Öcal Demir ◽  
Serkan Atici ◽  
Gülşen Akkoç ◽  
Nurhayat Yakut ◽  
Nilay Baş İkizoğlu ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Side Effects ◽  
Adverse Events ◽  
Pediatric Patients ◽  
Allergic Bronchopulmonary Aspergillosis ◽  
Therapeutic Drug ◽  
Color Sensation ◽  
First Case ◽  
Current Report ◽  
Visual Disturbances

Although voriconazole, a triazole antifungal, is a safe drug, treatment with this agent is associated with certain adverse events such as hepatic, neurologic, and visual disturbances. The current report presents two cases, one a 9-year-old boy and the other a 17-year-old girl, who experienced neurologic side effects associated with voriconazole therapy. Our aim is to remind readers of the side effects of voriconazole therapy in order to prevent unnecessary investigations especially for psychological and ophthalmologic problems. The first case was a 9-year-old boy with cystic fibrosis and invasive aspergillosis that developed photophobia, altered color sensation, and fearful visual hallucination. The second case was a 17-year-old girl with cystic fibrosis and allergic bronchopulmonary aspergillosis, and she experienced photophobia, fatigue, impaired concentration, and insomnia, when the dose of voriconazole therapy was increased from 12 mg/kg/day to 16 mg/kg/day. The complaints of the two patients disappeared after discontinuation of voriconazole therapy. Our experience in these patients reminded us of the importance of being aware of the neurologic adverse events associated with voriconazole therapy in establishing early diagnosis and initiating prompt treatment. In addition, although serum voriconazole concentration was not measured in the present cases, therapeutic drug monitoring for voriconazole seems to be critically important in preventing neurologic side effects in pediatric patients.

24 Comparison of the tolerability of posaconazole versus voriconazole in children with cystic fibrosis

2018 ◽  
Vol 103 (2) ◽  
pp. e2.27-e2 ◽  
Author(s):  
Sian Bentley ◽  
Sukeshi Makhecha ◽  
Siobhan Carr ◽  
Ian Balfour-Lynn ◽  
Jane Davies
Keyword(s):  
Cystic Fibrosis ◽  
Adverse Effects ◽  
Allergic Bronchopulmonary Aspergillosis ◽  
Antifungal Prophylaxis ◽  
Therapeutic Drug ◽  
Blood Levels ◽  
List Type ◽  
Retrospective Case ◽  
Clin Microbiol Infect ◽  
Hematopoietic Stem

BackgroundTriazole antifungals (itraconazole and voriconazole), are commonly used for treating isolates of Aspergillus, or in combination with corticosteroids for the empiric treatment of Allergic Bronchopulmonary Aspergillosis (ABPA) in children with cystic fibrosis (CF). Posaconazole is a newer triazole that is as effective, but better tolerated than voriconazole and itraconazole in immunocompromised patients1 though there is no published use in CF and it is not licensed in children<18 years old. It is used as a 3rd line agent for Aspergillus or ABPA in our institution.AimOur aim was to evaluate why posaconazole was needed in some children, and to assess its tolerability. Given the difficulty in reaching therapeutic drug levels of triazoles in children with CF2 we also reviewed posaconazole blood levels.MethodA retrospective case note review of all children with CF who had received voriconazole or posaconazole from April 2014 to May 2015 in a tertiary paediatric CF centre with a clinic population of 350 children. Children were identified from pharmacy records and clinical data was collected from case notes and computerised laboratory records. We compared reported adverse effects for both drugs, and for the posaconazole group documented reason for use and blood levels (therapeutic >0.7 mg/L).ResultsVoriconazole was used in 10 children with a median age of 13.5 years (range 12–16), for median 8 weeks. Adverse effects were experienced in 5/10 (50%) of children (photosensitivity – 4; hallucinations and nausea – 1), and 2 children had raised liver functions tests (LFTs). Posaconazole was used in 7 children with a median age of 14 years (range 13–16) for median 37 weeks. No adverse effects were reported but LFTs were raised in 1 child. Posaconazole was commenced in 6/7 (85%) children due to severe photosensitivity with voriconazole. Of these, posaconazole was indicated for concurrent Scedosporium isolates in 2 children, and therapeutic failure with itraconazole in 4 children. Posaconazole levels were consistently therapeutic in 5/7 (71%) children (range 0.7–2.47 mg/L). Levels in 1 child fell to <0.2 mg/L following the introduction of an interacting drug (rifampicin), and a level of 2.47 mg/L was associated with raised LFTs in another, resulting in discontinuation of posaconazole.ConclusionIn this small cohort, posaconazole was better tolerated than voriconazole for the treatment of Aspergillus or ABPA in children with CF, due mainly to the lack of photosensitivity associated with its use. Posaconazole levels attained from our patients indicate that therapeutic levels can be readily obtained in this patient population. Larger studies are needed to support these conclusions.ReferencesDoring M, Blume O, Haufe S, et al. Comparison of itraconazole, voriconazole, and posaconazole as oral antifungal prophylaxis in paediatric patients following allogeneic hematopoietic stem cell transplantation. Eur J Clin Microbiol Infect Dis2014;33(4):629–38.Bentley S, Gupta A, Balfour-Lynn IM. Subtherapeutic itraconazole and voriconazole levels in children with cystic fibrosis. J Cyst Fibros2013;12:418–9.

scholarly journals Safety and Tolerability of a Rapid Transition From Intravenous Treprostinil to Oral Selexipag in Three Adolescent Patients With Pulmonary Arterial Hypertension

2021 ◽  
Vol 26 (5) ◽  
pp. 512-516
Author(s):  
Elizabeth Colglazier ◽  
Angelica J. Ng ◽  
Claire Parker ◽  
Hythem Nawaytou ◽  
Jeffrey R. Fineman
Keyword(s):  
Pulmonary Arterial Hypertension ◽  
Side Effects ◽  
Adverse Events ◽  
Pediatric Patients ◽  
Case Series ◽  
Inpatient Setting ◽  
Inpatient Hospitalization ◽  
Adolescent Patients ◽  
Rapid Transition ◽  
Pulmonary Arterial

There is limited published experience with transitioning pediatric patients from parenteral treprostinil to oral selexipag therapy. In addition, published transitions have typically been protracted, taking several weeks to complete. We present a case series of 3 adolescent patients who were transitioned from parenteral treprostinil to oral selexipag over a 5- to 7-day period. Their clinical courses leading up to the transitions are summarized and their outcomes are described. The 3 patients were successfully rapidly transitioned during an inpatient hospitalization without any observed adverse events or prostacyclin-related side effects. We conclude that when indicated rapid transition of parenteral to oral prostacyclin therapy may be performed safely in adolescents in an inpatient setting.

Arthropathy Secondary to Ciprofloxacin in an Adult Cystic Fibrosis Patient

1993 ◽  
Vol 27 (3) ◽  
pp. 302-303 ◽  
Author(s):  
Wayne M. Samuelson ◽  
Roy A. Pleasants ◽  
Martha S. Whitaker
Keyword(s):  
Cystic Fibrosis ◽  
Adult Patient ◽  
Cystic Fibrosis Patient ◽  
Pediatric Patients ◽  
Prior History ◽  
Case Summary ◽  
First Case ◽  
Acute Exacerbations ◽  
History Of ◽  
Possible Cause

OBJECTIVE: To report a case of possible ciprofloxacin-induced arthropathy in an adult patient with cystic fibrosis (CF). CASE SUMMARY: A 25-year-old man with CF received three separate courses of ciprofloxacin therapy at usual doses for acute pulmonary exacerbations of his disease. During the second and third courses, the patient experienced bilateral swelling of his knees between two to three weeks after initiation of each course. Both times symptoms markedly decreased after discontinuation of the drug. The patient had no prior history of arthropathy. Furthermore, during the last two acute exacerbations of his CF, he did not receive ciprofloxacin and did not experience any symptoms of arthropathy. DISCUSSION: Prior cases of quinolone-induced arthropathy involving pediatric CF patients or adult patients without CF have been reported in the literature. We report the first case of such an arthropathy in an adult patient with CF. The findings are supported by a rechallenge with the drug. CONCLUSIONS: It is likely that ciprofloxacin may produce arthropathy in adult as well as pediatric patients with CF. Quinolones should be considered as a possible cause of arthropathy in adult CF patients.

scholarly journals Toxicity of fipronil in rabbits as a therapeutic drug for "Psoroptes cuniculi": A preliminary observation

2018 ◽  
Vol 2 (3) ◽  
pp. 260-265 ◽  
Author(s):  
Nagwa M. Elhawary ◽  
Shimaa S.Gh. Sorour ◽  
Eman K. Bazh ◽  
Moshira A. El- Abasy ◽  
Mostafa A. El-Madawy ◽  
...  
Keyword(s):  
Body Weight ◽  
Side Effects ◽  
Adverse Effects ◽  
Preliminary Observation ◽  
Post Treatment ◽  
Therapeutic Drug ◽  
Psoroptes Cuniculi ◽  
Limited Efficacy ◽  
Current Report

In the current report, a preliminary observation to study the adverse effects of the broad use acaricides fipronil (FPN) in rabbits infested with Psoroptes cuniculi. Two separate groups (5 rabbits/each) treated topically (poured on at the base of the neck) with fipronil 5%, 1 vial/ 10 kilogram body weight (kg bw) and 1 vial/ 5 kg bw. After FPN spot on application, rabbits in both groups examined microscopically on the 7th, 14th, and 28th day post treatment and the number of live mites (larvae, nymphs, and adults) on each rabbit counted at the end of the experiment (28th day). The results showed that the number of mites in rabbits topically treated with FPN did not show significant decrease, moreover a decrease in both treated rabbits body weight (bw) and in performance observed clearly, with some attendant mortality. In conclusion, this work showed that FPN was with limited efficacy on P. cuniculi and had some undesirable side effects. Further and in-depth studies on FPN toxicity in rabbits and other animals are necessary.

scholarly journals Posaconazole for the treatment of allergic bronchopulmonary aspergillosis in patients with cystic fibrosis

2019 ◽  
Vol 74 (6) ◽  
pp. 1701-1703 ◽  
Author(s):  
J Periselneris ◽  
L Nwankwo ◽  
S Schelenz ◽  
A Shah ◽  
D Armstrong-James
Keyword(s):  
Cystic Fibrosis ◽  
Systemic Corticosteroid ◽  
Allergic Bronchopulmonary Aspergillosis ◽  
Drug Level ◽  
Corticosteroid Treatment ◽  
Specific Ige ◽  
Therapeutic Drug ◽  
Serological Response ◽  
Lung Function Decline ◽  
Better Than

Abstract Objectives Allergic bronchopulmonary aspergillosis (ABPA) can accelerate lung function decline in patients with cystic fibrosis (CF). Antifungal medication can be used in addition to systemic corticosteroid treatment. Patients and methods We evaluated Aspergillus-specific IgE and the use of therapeutic drug monitoring of triazoles in a retrospective analysis of 32 patients. Results There was a significant reduction in Aspergillus IgE with posaconazole but not with other triazoles (P = 0.026). Aspergillus IgE levels were inversely correlated with the therapeutic drug level of posaconazole. Conclusions These data suggest that posaconazole is better than comparator azoles at decreasing serological response to Aspergillus and that this response was better with therapeutic levels of posaconazole.

scholarly journals Steroid Sparing Effect of Omalizumab in Seropositive Allergic Bronchopulmonary Aspergillosis

2015 ◽  
Vol 6 (2) ◽  
pp. ar.2015.6.0128 ◽  
Author(s):  
Keith T. Beam ◽  
Christopher A. Coop
Keyword(s):  
Cystic Fibrosis ◽  
Side Effects ◽  
Respiratory Symptoms ◽  
Immunoglobulin E ◽  
Allergic Bronchopulmonary Aspergillosis ◽  
Steroid Use ◽  
Sparing Effect ◽  
Airway Colonization ◽  
Steroid Sparing

Background Allergic bronchopulmonary aspergillosis (ABPA) is a common serious hypersensitivity reaction to airway colonization with Aspergillus in patients with asthma or cystic fibrosis. While steroids are effective in controlling the respiratory symptoms of ABPA, they have many side effects that make them undesirable for long term use. Antifungals have been used to reduce dependency on systemic steroids but long term use can be limited by side effects and there is the possibility of developing resistance to azoles. Some clinicians have successfully used anti-immunoglobulin E (anti-IgE) therapy in various populations, though it is frequently added to antifungals. Objective Further describe the utility of anti-IgE therapy for ABPA for patients unable to tolerate antifungals. Methods We describe the case of a patient with serologic ABPA who did not tolerate therapy with antifungals but was able to significantly reduce her average daily steroid use while receiving anti-IgE therapy with omalizumab added to her other respiratory medications. Results After therapy with omalizumab, our patient was able to reduce her need for daily corticosteroids by nearly 80%. Conclusions Omalizumab may reduce corticosteroid dependence in patients with allergic bronchopulmonary aspergillosis for patients unable to tolerate antifungals, though use may be limited by cost. Additional studies are needed. ClinicalTrial.gov identifier NCT00787917.

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