What is the typical treatment regimen for a 10-year-old boy weighing 30 kg with Allergic Bronchopulmonary Aspergillosis (ABPA)?

Treatment Prescription for a 10-year-old, 30 kg Boy with ABPA

For a 10-year-old boy weighing 30 kg with Allergic Bronchopulmonary Aspergillosis (ABPA), the recommended first-line treatment is oral prednisolone at 0.5 mg/kg/day (15 mg daily) for 2-4 weeks, followed by a gradual taper over 4 months, along with appropriate antifungal therapy. 1, 2

Initial Treatment Regimen

Corticosteroid Therapy

• Prednisolone 15 mg (0.5 mg/kg/day) orally once daily for 2-4 weeks 1
• Then taper to 15 mg on alternate days for 8 weeks 1, 2
• Further taper by 5 mg every 2 weeks until discontinuation, completing a total 4-month course 1, 2

Antifungal Therapy (Choose one)

• Itraconazole capsules 100 mg twice daily (total 200 mg/day) with meals for 4 months 1
  • Maximum dose should not exceed 600 mg/day 1
  • Monitor for drug interactions with prednisolone 1
  • Therapeutic drug monitoring recommended (target trough level ≥0.5 mg/L) 1

Monitoring Parameters

• Clinical symptoms assessment every 4 weeks 1, 3
• Serum total IgE levels every 6-8 weeks 3, 2
• Chest radiograph at baseline and after 8-12 weeks of therapy 3
• Liver function tests monthly if on itraconazole 1

Treatment Response Assessment

• Good response defined as:
  • ≥50% improvement in symptoms on Likert scale 3
  • Improvement on chest imaging 3
  • At least 20% reduction in serum total IgE levels 3

Special Considerations

For Severe or Recurrent Cases

• Consider combination therapy with prednisolone and itraconazole if:
  • Blood eosinophil count ≥1000 cells/μL 3
  • Extensive bronchiectasis (≥10 segments) 1, 3

Alternative Options for Steroid-Resistant Cases

• Voriconazole 200 mg twice daily (maximum 600 mg/day) if itraconazole is not tolerated 1
• Consider biological agents like omalizumab or mepolizumab in steroid-dependent cases 1, 4

Potential Adverse Effects to Monitor

• Corticosteroid-related: hyperglycemia, growth suppression, cushingoid features, osteoporosis 1
• Itraconazole-related: headache, gastritis, nausea, liver toxicity 1
• Combination therapy increases risk of exogenous Cushing's syndrome 1

Important Pitfalls to Avoid

• Do not use methylprednisolone with itraconazole due to higher risk of Cushing's syndrome 1
• Avoid high-dose inhaled corticosteroids with itraconazole due to potential drug interactions 1
• Do not discontinue treatment abruptly; always taper steroids gradually 5
• Monitor for vitamin D deficiency and consider supplementation to prevent osteopenia 3

The goal of treatment is to control symptoms, prevent exacerbations, halt bronchiectasis progression, and minimize therapy-related adverse events 1, 2.