Voriconazole Use in Children : Therapeutic Drug Monitoring and Control of Inflammation as Key Points for Optimal Treatment
Valle-T-Figueras, José María (Institut d'Investigació Biomèdica Sant Pau)
Renedo-Miró, Berta (Hospital Universitari Vall d'Hebron)
Benítez Carabante, Maria Isabel (Hospital Universitari Vall d'Hebron)
Díaz de Heredia, Cristina (Hospital Universitari Vall d'Hebron)
Vima Bofarull, Jaume (Hospital Universitari Vall d'Hebron)
Mendoza-Palomar, Natalia Ana (Hospital Universitari Vall d'Hebron)
Martin-Gomez, M. Teresa (Hospital Universitari Vall d'Hebron)
Soler-Palacín, Pere (Hospital Universitari Vall d'Hebron)
Universitat Autònoma de Barcelona

Data:	2021
Resum:	Voriconazole plasma concentrations (PC) are highly variable, particularly in children. Dose recommendations in 2-12-year-old patients changed in 2012. Little data on therapeutic drug monitoring (TDM) after these new recommendations are available. We aimed to evaluate voriconazole monitoring in children with invasive fungal infection (IFI) after implementation of new dosages and its relationship with safety and effectiveness. A prospective, observational study, including children aged 2-12 years, was conducted. TDM was performed weekly and doses were changed according to an in-house protocol. Effectiveness, adverse events, and factors influencing PC were analysed. A total of 229 PC from 28 IFI episodes were obtained. New dosing led to a higher rate of adequate PC compared to previous studies; still, 35. 8% were outside the therapeutic range. In patients aged < 8 years, doses to achieve therapeutic levels were higher than recommended. Severe hypoalbuminemia and markedly elevated C-reactive protein were related to inadequate PC. Therapeutic PC were associated with drug effectiveness and safety. Higher doses in younger patients and a dose adjustment protocol based on TDM should be considered. Voriconazole PC variability has decreased with current updated recommendations, but it remains high and is influenced by inflammatory status. Additional efforts to control inflammation in children with IFI should be encouraged.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Paediatric fungal infections ; Antifungal treatment ; Therapeutic drug monitoring ; Voriconazole ; Children ; Inflammation
Publicat a:	Journal of Fungi, Vol. 7 (june 2021) , ISSN 2309-608X

DOI: 10.3390/jof7060456
PMID: 34200506

17 p, 555.8 KB

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