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Suggest Treatment For Nausea, Vomiting And Headaches

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Posted on Mon, 27 Jul 2015
Question: my daughter was recently on voraconazole firstly for candida, then posaconazole, then IV fluconozole and IV amphotericin B over the course of three months. She was also on IV Cefepime, IV ciproflaxicin, norfloxicin, IV teicoplanin, prednisone, zoton, amlodipine, lisinopril, maxalon, ondansatron and many other medications at the same time as the antifungals. My questions are these: Can voriconazole predispose people to mucor infection (which is the fungus the grew firstly in her urine and then in her blood culture) following a course of Voriconazole. She ended up in renal failure following three days of 200mg QID posaconazole which had been a follow on course of antifungals after three days of amphotericin B 5mg/kg/day with no congenital cause. I am wondering if the combination of all of these medications could cause acute renal injury. Finally, with that combination of antifungals and antibiotics and immune suppressants could that possibly cause polymicrobial growth in blood? She has a specific antibody deficiency, with neutrophil and innate system dysfunction. She had many side effects from these medications, including, nausea, vomiting, headache and peeling skin.

thank you.
doctor
Answered by Dr. Arun (1 hour later)
Brief Answer:
possible by voriconazole

Detailed Answer:
Hi
Thanks for writing to us.
1. Voriconazole is not recommended for mucormycosis.
Amphoterecin B is the drug of choice. Many studies have reported that patients who are on voriconazole prophylaxis after Transplant get predisposed to mucormycosis. So in your child voriconazole could have promoted mucormycosis to dominate.
2. Renal failure is unlikely due to voriconazole. It usually causes liver injury and visual disturbance and no effect on kidney. Amphoterecin is a well known cause of renal injury.
3. Amphoterecin and antibiotics along with the mucormycosis by itself all put together could be responsible for the renal injury.
I do hope she is getting better now.
Wishing your child good health and speedy recovery.
Regards
Dr Arun
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Arun (17 hours later)
Could three days of posaconazole following three days of amphotericin cause acute renal failure?

Could the combination of high dose steroids, antibiotics and antifungals place an immune deficient child at risk of polymicrobial (candida and mucor) blood infection.
At the time of infection, she had not received any antifungals for 48 hours.
doctor
Answered by Dr. Arun (2 hours later)
Brief Answer:
possible

Detailed Answer:
Both the scenarios are possible.
Some kids may be sensitive to amphoterecin and renal failure can occur even in 3 days.
Steroids are well known to promote polymicrobial infection.
Regards
Note: For further queries related to your child health, Talk to a Pediatrician. Click here to Book a Consultation.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Arun

Pediatrician, Pulmonology

Practicing since :2003

Answered : 1964 Questions

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Suggest Treatment For Nausea, Vomiting And Headaches

Brief Answer: possible by voriconazole Detailed Answer: Hi Thanks for writing to us. 1. Voriconazole is not recommended for mucormycosis. Amphoterecin B is the drug of choice. Many studies have reported that patients who are on voriconazole prophylaxis after Transplant get predisposed to mucormycosis. So in your child voriconazole could have promoted mucormycosis to dominate. 2. Renal failure is unlikely due to voriconazole. It usually causes liver injury and visual disturbance and no effect on kidney. Amphoterecin is a well known cause of renal injury. 3. Amphoterecin and antibiotics along with the mucormycosis by itself all put together could be responsible for the renal injury. I do hope she is getting better now. Wishing your child good health and speedy recovery. Regards Dr Arun