M041: ITRACONAZOLE TREATMENT OF ALLERGIC BRONCHO PULMONARY
ASPERGILLOSIS IN CYSTIC FIBROSIS CHILDREN
C. Marguet, N. Sannier, O. Mouterde, E. Mallet.
(Respiratory and Infectious Diseases, Hopital Charles Nicolle,
Rouen, France)
Allergic bronchopulmonary aspergillosis (ABPA) is due to Aspergillus Fumigatus (AF) and is an usual infectious complication of cystic fibrosis (CF). Diagnosis is difficult associating clinical and biological data. Treatment of ABPA is discussed, and Itraconazole (I) is the only available oral antifungal drug active against AF We report 5 cases of children aged 3 to 16 being treated more than 3 months with 10mg/kg itraconazole once a day. (I) + metabolites serum concentration survey show initially levels > 1000 ns/ml which are therapeutic, then levels progressively decrease leading to clinical relapses in 3 cases which respond to increased (I) doses. A 10 mg/kg/day (I) appears to be an efficient and well tolerated (no side effects observed) ABPA treatment in CF and permit to spare cortosteroids. However, serum levels must be measured to adapt dose.
Age AF in Prick Blood (G/l) Grade AF Worsened Response
sputum Test Eosinophilis RAST AF Elisa RX Treatment
Features
6 + + 0.52 5 1323 + S*
16 + + 0.177 ND ND + S*
6 + + 1.32 4 762 + S*
3 + - 0.17 3 0 + 1*
3 - + 0.52 2 293 + S*
S = Successful, I = Improvement
* Necessity to increase ( I) dose after 3 months