title: The Clinical Significance of Voriconazole Therapeutic Drug Monitoring in Children With Invasive Fungal Infections.
abstract: Voriconazole is an antifungal drug used to treat fungal infections. This was a retrospective study of 61 children with hemato-oncologic diseases or solid organ transplantation who were administered voriconazole for invasive fungal infections. Of the 61 patients, 31 (50.8%) were in the therapeutic drug monitoring (TDM) group, and 30 (49.2%) were in the non-TDM group. At 12 weeks, treatment failure rate in the non-TDM group was higher than the TDM group (78.6% versus 40.0%, p = 0.038). Drug discontinuation due to adverse events was less frequent in the TDM group than the non-TDM group (26.0% versus 92.3%, p = 0.001). Children required higher dosages to maintain drug levels within the targeted therapeutic range: an average of 8.3 mg/kg/dose in patients <12 years old and 6.9 mg/kg/dose for those ≥12 years old. Treatment failure rates were higher in patients whose voriconazole levels remained below 1.0 mg/L for more than 50% of their treatment duration than those above 1.0 mg/L (71.4% vs. 9.1% after 12 weeks, p = 0.013). Serial monitoring of voriconazole levels in children is important for improving treatment response and preventing unnecessary drug discontinuation. Higher dosages are needed in children to reach therapeutic range.
authors.affiliation: a Department of Pediatrics , Seoul National University Hospital , Seoul , South Korea.|b Department of Pediatrics , Seoul National University College of Medicine , Seoul , South Korea.
authors.forename: Hyun Mi
authors.initials: HM
authors.lastname: Kang
authors.affiliation: a Department of Pediatrics , Seoul National University Hospital , Seoul , South Korea.|b Department of Pediatrics , Seoul National University College of Medicine , Seoul , South Korea.
authors.forename: Hoan Jong
authors.initials: HJ
authors.lastname: Lee
authors.affiliation: b Department of Pediatrics , Seoul National University College of Medicine , Seoul , South Korea.|c Department of Pediatrics , Chungnam National University Hospital , Daejeon , South Korea.
authors.forename: Eun Young
authors.initials: EY
authors.lastname: Cho
authors.affiliation: d Department of Clinical Pharmacology and Therapeutics , Seoul National University College of Medicine , Seoul , South Korea.
authors.forename: Kyung-Sang
authors.initials: KS
authors.lastname: Yu
authors.affiliation: b Department of Pediatrics , Seoul National University College of Medicine , Seoul , South Korea.|e Department of Pediatrics , Seoul National University Bundang Hospital , Seongnam , South Korea.
authors.forename: Hyunju
authors.initials: H
authors.lastname: Lee
authors.affiliation: a Department of Pediatrics , Seoul National University Hospital , Seoul , South Korea.|f Department of Pediatrics , Cancer Research Institute, Seoul National University College of Medicine , Seoul , South Korea.
authors.forename: Ji Won
authors.initials: JW
authors.lastname: Lee
authors.affiliation: a Department of Pediatrics , Seoul National University Hospital , Seoul , South Korea.|f Department of Pediatrics , Cancer Research Institute, Seoul National University College of Medicine , Seoul , South Korea.
authors.forename: Hyoung Jin
authors.initials: HJ
authors.lastname: Kang
authors.affiliation: a Department of Pediatrics , Seoul National University Hospital , Seoul , South Korea.|f Department of Pediatrics , Cancer Research Institute, Seoul National University College of Medicine , Seoul , South Korea.
authors.forename: Kyung Duk
authors.initials: KD
authors.lastname: Park
authors.affiliation: a Department of Pediatrics , Seoul National University Hospital , Seoul , South Korea.|f Department of Pediatrics , Cancer Research Institute, Seoul National University College of Medicine , Seoul , South Korea.
authors.forename: Hee Young
authors.initials: HY
authors.lastname: Shin
authors.affiliation: a Department of Pediatrics , Seoul National University Hospital , Seoul , South Korea.|b Department of Pediatrics , Seoul National University College of Medicine , Seoul , South Korea.
authors.forename: Eun Hwa
authors.initials: EH
authors.lastname: Choi
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D019337:Hematologic Neoplasms; D006801:Humans; D008297:Male; D009181:Mycoses / Q000097:blood* / Q000188:drug therapy* / Q000209:etiology; D016377:Organ Transplantation; D013997:Time Factors; D065819:Voriconazole / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics*
chemical_list: D065819:Voriconazole
keywords: adverse events; children; therapeutic drug monitoring; treatment response; voriconazole