Antifungal-Related Adverse Reactions in Children: Which Drug Is Safest?

Adverse drug reactions vary across antimicrobial drug class, but amphotericin induces the most frequent adverse reactions, according to new data presented at IDWeek 2018.

The report, authored by Dr Jennifer Goldman and colleagues, will be presented on Thursday, October 4, at IDWeek 2018 in San Francisco.

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For their study, Goldman and colleagues examined the results of quarterly pediatric point prevalence surveys, which documented patients aged 0 to 17 years who were admitted to 32 hospitals in the United States and were taking antimicrobial therapy.

Data included in their analysis was drug name and class, dose, and documented history of an antimicrobial adverse event between June 2016 and December 2017.

Goldman and colleagues also compared the antifungal prescribing practices between those with and those without a recorded adverse event.

Overall, 13,179 participants were included in the analysis. Of those, 2213 antifungal medications were prescribed to 2101 unique participants.

Only 2.9% of participants taking an antifungal had experienced an adverse event.

Amphotericin was most commonly associated with adverse events. Participants with an amphotericin adverse event were more likely to receive voriconazole, compared with those without an adverse event (29% vs 15%, respectively).

Adverse events related to echinocandin were uncommon, and 62% of those with a reported adverse event still received an echinocandin.

Fluconazole was the most commonly prescribed antifungal among participants with no adverse events, compared with those with an antifungal-related adverse event (49% vs 13%, respectively).

In addition, use of posaconazole was highest among those with an azole adverse event, compared with those with no azole adverse event (22% vs 4%, respectively).

“Significant differences in antifungal prescribing exists based on [adverse drug reactions] status,” the researchers wrote. “More work is needed to be able to effectively classify AF [adverse drug reactions], determine safe prescribing practices in those with an AF [adverse drug reactions], and evaluate outcomes associated with AF [adverse drug reactions] status.”

—Amanda Balbi

Reference:

Goldman J, Newland J, Yu D, et al. Impact of pediatric antifungal adverse drug reactions on prescribing practices. Paper presented at: IDWeek 2018; October 3-7, 2018; San Francisco, CA. https://idsa.confex.com/idsa/2018/webprogram/Paper70207.html. Accessed October 2, 2018.