Therapeutic drug monitoring of voriconazole in pediatric patients

J.W.M. Van der Linden, R.J.M. Brüggemann, J. Knoop, P.E. Verweij, D.M. Burger, A. Warris

Author address: 

Radboud University Medical Center, NIJMEGEN, The Netherlands

Abstract: 

Objectives: Voriconazole (VCZ) has a wide inter- and intra-individual pharmacokinetic variability. It is unclear if the officially recommended dosages for pediatric patients are sufficient to achieve adequate exposure. Methods: All pediatric patients (age 0-18) in our children’s hospital with at least one measured plasma trough level of VCZ, during a 2-year period (May 2007 and May 2009) were included. Case report forms were used to collect information on patients characteristics like underlying disease, fungal infection, treatment regimen and outcome. Results: A total of 15 patients (age 3 mo - 16 yrs) were included. Majority of patients (12) suffered from hematologic malignancies, 2 were diagnosed with cystic fibrosis and 1 patient with a solid tumor. Six patients had proven IFI (4 Aspergillus spp., 1 C. albicans, 1 F. solani), one had probable IFI and 6 had possible IFI, according to the EORTC-MSG 2008 criteria. The 2 CF-patients suffered from an exacerbation of allergic broncho-pulmonary aspergillosis. In most of the patients (8) fungal pneumonia was diagnosed, and 2 had liver infiltrates or abscesses. Disseminated bloodstream infection was present in 2 patients, and in 1 patient the IFI was localized in the CNS. Children 12 years (n=3) were treated for a median duration of 49 days [ range 12 -126 days] with a median daily dose of 8 mg/kg [range 7.2- 8.8 mg/kg]. Number of trough concentrations determined in individual patients ranged from 1 to 14 samples. Forty trough concentrations of VCZ were collected. Mean trough concentrations in children 12 yrs. Fourteen (35%) trough concentrations of VCZ were
2009

abstract No: 

02.6

Full conference title: 

4th Trends in Medical Mycology
    • TIMM 4th (2012)