title: Voriconazole pharmacokinetics and safety in immunocompromised children compared to adult patients.
abstract: The aim of this study was to investigate the pharmacokinetics and safety of voriconazole after intravenous (i.v.) administration in immunocompromised children (2 to 11 years old) and adults (20 to 60 years old) who required treatment for the prevention or therapy of systemic fungal infections. Nine pediatric patients were treated with a dose of 7 mg/kg i.v. every 12 h for a period of 10 days. Three children and 12 adults received two loading doses of 6 mg/kg i.v. every 12 h, followed by a maintenance dose of 5 mg/kg (children) or 4 mg/kg (adults) twice a day during the entire study period. Trough voriconazole levels in blood over 10 days of therapy and regular voriconazole levels in blood for up to 12 h postdose on day 3 were examined. Wide intra- and interindividual variations in plasma voriconazole levels were noted in each dose group and were most pronounced in the children receiving the 7-mg/kg dose. Five (56%) of them frequently had trough voriconazole levels in plasma below 1 microg/ml or above 6 microg/ml. The recommended dose of 7 mg/kg i.v. in children provides exposure (area under the concentration-time curve) comparable to that observed in adults receiving 4 mg/kg i.v. The children had significantly higher C(max) values; other pharmacokinetic parameters were not significantly different from those of adults. Voriconazole exhibits nonlinear pharmacokinetics in the majority of children. Voriconazole therapy was safe and well tolerated in pediatric and adult patients. The European Medicines Agency-approved i.v. dose of 7 mg/kg can be recommended for children aged 2 to <12 years.
authors.affiliation: Institute of Clinical Pharmacology, Faculty of Medicine, University of Leipzig, and University Children's Hospital, Department of Pediatric Hematology and Oncology, Haertelstrasse 16/18, 04107 Leipzig, Germany. Claudia.Michael@medizin.uni-leipzig.de
authors.forename: Claudia
authors.initials: C
authors.lastname: Michael
authors.forename: Uta
authors.initials: U
authors.lastname: Bierbach
authors.forename: Katrin
authors.initials: K
authors.lastname: Frenzel
authors.forename: Thoralf
authors.initials: T
authors.lastname: Lange
authors.forename: Nadezda
authors.initials: N
authors.lastname: Basara
authors.forename: Dietger
authors.initials: D
authors.lastname: Niederwieser
authors.forename: Christine
authors.initials: C
authors.lastname: Mauz-Körholz
authors.forename: Rainer
authors.initials: R
authors.lastname: Preiss
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics*; D019540:Area Under Curve; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy*; D011743:Pyrimidines / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics*; D016896:Treatment Outcome; D014230:Triazoles / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics*; D065819:Voriconazole; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole