Intravenous to oral switch for invasive pulmonary aspergillosis in children

Once children with invasive pulmonary aspergillosis improve, switch to oral or enteral therapy (for guidance on when to switch to oral therapy, see Guidance for intravenous to oral switch).

For children younger than 2 years, seek expert advice for oral antifungal choice for invasive pulmonary aspergillosis.

For children 2 years or older, for oral continuation therapy for invasive pulmonary aspergillosis, useDouglas, 2021:

voriconazole orally (or enterally¹)². Take either 1 hour before or 1 hour after a meal. Monitor plasma concentration. See advice on duration of therapy voriconazole

child 2 to younger than 12 years: 9 mg/kg up to 350 mg, 12-hourly

child 12 to younger than 15 years and less than 50 kg: 9 mg/kg up to 350 mg, 12-hourly

child 12 to younger than 15 years and 50 kg or more: 200 mg, 12-hourly³

child 15 years or older: 200 mg, 12-hourly³ ⁴.

For children who are not improving with voriconazole or amphotericin B liposomal, options for salvage therapy are limited – seek expert advice and consult specialist guidelines (eg Consensus guidelines for the diagnosis and management of invasive aspergillosis).

¹ For advice on optimising absorption of enterally administered voriconazole, consult Don’t Rush to Crush, which is available for purchase from the Advanced Pharmacy Australia website or through a subscription to eMIMSplus.Return

² Studies have suggested that voriconazole does not distribute extensively into adipose tissue, so dosing in children with obesity should be based on either ideal body weight (IBW) or adjusted body weight Davies-Vorbrodt, 2013 Koselke, 2012.Return

³ If voriconazole was not used as initial intravenous therapy, give a loading dose of voriconazole 400 mg orally, 12-hourly for 2 doses.Return

⁴ Children 15 years or older who are underweight (eg weigh less than 40 kg) may require a lower dose.Return