Voriconazole plasma monitoring.
OBJECTIVE
Very little information is available regarding the use of voriconazole drug monitoring in children with invasive fungal infections. The purpose of this study was to report the cases of five paediatric patients treated with voriconazole, in which plasma levels were used to monitor therapy.


METHODS
Five children treated with voriconazole were included in this case series. Voriconazole plasma levels were determined using either a bioassay or liquid chromatography-tandem mass spectrometry.


RESULTS
The patients' ages ranged from 2 to 10 years old (mean 6.2 years). Three patients had acute leukaemia and two had suffered severe burn injuries. Doses administered varied from 3.4 mg/kg every 12 h to 8.1 mg/kg every 8 h. Plasma voriconazole concentrations were unpredictable for these paediatric patients. Subtherapeutic levels were frequently observed, despite progressive increments in dosage. For others, voriconazole levels markedly increased after a small increment in dosage. Phenobarbitone caused important drug interactions with voriconazole for one [corrected] of the patients.


CONCLUSIONS
The dose administered did not correlate with exposure as measured by plasma levels of voriconazole. While the optimal dosage for voriconazole in children is still unknown, drug monitoring seems warranted to ensure adequate exposure, and after dose increments to prevent excessive exposure. Drug interactions significantly altered exposure.
Pasqualotto
A C
AC
Alessandro Pasqualotto, Education and Research Centre, Wythenshawe Hospital, Southmoor Road, Manchester, M23 9LT, UK. acpasqualotto@hotmail.com
Shah
M
M
Wynn
R
R
Denning
D W
DW
D000935:Antifungal Agents / Q000008:administration & dosage / Q000097:blood*; D001228:Aspergillosis / Q000097:blood* / Q000150:complications / Q000188:drug therapy; D002648:Child; D002675:Child, Preschool; D004334:Drug Administration Schedule; D016903:Drug Monitoring / Q000379:methods*; D006801:Humans; D007938:Leukemia / Q000150:complications; D009894:Opportunistic Infections / Q000097:blood / Q000150:complications / Q000188:drug therapy; D011743:Pyrimidines / Q000008:administration & dosage / Q000097:blood*; D014230:Triazoles / Q000008:administration & dosage / Q000097:blood*; D065819:Voriconazole
D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole