title: Pharmacokinetic considerations in the use of antivirals in neonates.
abstract: BACKGROUND
  Neonatal patients, because of the inability of their immune system to properly respond to microbial challenge, are highly susceptible to viral infections. Immunoglobulins, monoclonal antibody and antiviral drugs are used for prophylaxis and treatment of viral diseases in neonates. Neonates and, especially, preterm infants differ in drug absorption, distribution, metabolism and excretion from adults and older children.
  
  
  METHODS
  This review will evaluate deficiencies of neonatal immune responses to microbial challenge that predispose newborns to viral infections, clinical manifestations and the treatment of viral diseases in neonates. We focus on published studies describing antiviral drug pharmacokinetics in neonates and make recommendations on the dosing of these drugs, allowing achievement of maximal clinical benefits in neonates.
  
  
  CONCLUSIONS
  While some efforts were undertaken to study pharmacokinetics and pharmacodynamics of antiviral drugs, much more needs to be done. Current data indicate that the pharmacokinetics of antiviral drugs may vary significantly depending on gestational age, maturation processes of drug-metabolizing enzymes and renal clearance. Specifics of pharmacokinetics of antiviral drugs need to be taken into consideration when they are prescribed to neonates and infants.
authors.affiliation: a Division of Clinical Pharmacology, Department of Pediatrics , University of Utah School of Medicine , 295 Chipeta Way, Salt Lake City , UT 84108 , USA.|b Division of Microbiology and Immunology, Department of Pathology , University of Utah School of Medicine , 15 North Medical Drive East, Salt Lake City , UT 84112 , USA.
authors.forename: Elena Yu
authors.initials: EY
authors.lastname: Enioutina
authors.affiliation: a Division of Clinical Pharmacology, Department of Pediatrics , University of Utah School of Medicine , 295 Chipeta Way, Salt Lake City , UT 84108 , USA.
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Constance
authors.affiliation: a Division of Clinical Pharmacology, Department of Pediatrics , University of Utah School of Medicine , 295 Chipeta Way, Salt Lake City , UT 84108 , USA.
authors.forename: Chris
authors.initials: C
authors.lastname: Stockmann
authors.affiliation: a Division of Clinical Pharmacology, Department of Pediatrics , University of Utah School of Medicine , 295 Chipeta Way, Salt Lake City , UT 84108 , USA.
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Linakis
authors.affiliation: a Division of Clinical Pharmacology, Department of Pediatrics , University of Utah School of Medicine , 295 Chipeta Way, Salt Lake City , UT 84108 , USA.
authors.forename: Tian
authors.initials: T
authors.lastname: Yu
authors.affiliation: a Division of Clinical Pharmacology, Department of Pediatrics , University of Utah School of Medicine , 295 Chipeta Way, Salt Lake City , UT 84108 , USA.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Rower
authors.affiliation: a Division of Clinical Pharmacology, Department of Pediatrics , University of Utah School of Medicine , 295 Chipeta Way, Salt Lake City , UT 84108 , USA.
authors.forename: Alfred H
authors.initials: AH
authors.lastname: Balch
authors.affiliation: a Division of Clinical Pharmacology, Department of Pediatrics , University of Utah School of Medicine , 295 Chipeta Way, Salt Lake City , UT 84108 , USA.
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Sherwin
mesh_terms: D000328:Adult; D000367:Age Factors; D000818:Animals; D000998:Antiviral Agents / Q000008:administration & dosage / Q000493:pharmacokinetics*; D002648:Child; D004198:Disease Susceptibility / Q000276:immunology; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007107:Immune System / Q000502:physiology*; D007231:Infant, Newborn; D007234:Infant, Premature; D014777:Virus Diseases / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology
chemical_list: D000998:Antiviral Agents
keywords: :antiviral drugs; HIV; enteroviruses; herpes viruses; influenza; neonates; pharmacokinetics of antiviral drugs in neonates