کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | نسخه تمام متن |
---|---|---|---|---|
5666833 | 1591744 | 2017 | 5 صفحه PDF | دانلود رایگان |

- Only 47.7% of children reached the therapeutic target at initial voriconazole dosing.
- Voriconazole exposure is significantly increased with omeprazole co-administration.
- A starting maintenance dose of 5-7âmg/kg is recommended for Asian children aged <2 years.
The pharmacokinetic profile of voriconazole is highly variable, rendering inconsistent and/or inadequate dosing, especially in children <2 years old. A retrospective analysis was performed in children receiving voriconazole with at least one plasma trough level (Ctrough) monitored. Statistical analyses were performed to examine the dose-exposure relationship as well as other factors potentially affecting voriconazole Ctrough in children of different ages. A total of 107 paediatric patients were included, of whom 75 were <2 years old. The voriconazole Ctrough was highly variable in patients aged <2 years and those aged 2-12 years. Only 47.7% of children reached the therapeutic target of 1.0-5.5âmg/L at initial dosing, whereas 48.6% of Ctrough values were subtherapeutic and 3.7% were supratherapeutic. The mean maintenance dose to reach an adequate Ctrough was 5.9âmg/kg compared with 5.1âmg/kg, resulting in insufficient levels (Pâ=â0.005) in children aged <2 years. In this age group, the 5 to <7âmg/kg dose range significantly increased the chance of reaching the therapeutic target compared with the 3 to <5âmg/kg dose range (56.7% vs. 25.8%; Pâ=â0.014). Overall, factors such as sex, age, liver function, renal function and co-administered medications explained only 15.9% of variability in voriconazole exposure. Co-administration of omeprazole significantly increased the voriconazole level (Pâ=â0.032), likely through CYP2C19 inhibition. This is the largest series to date describing voriconazole dose-exposure relationships in children aged <2 years. A starting maintenance dose of 5 to <7âmg/kg intravenously twice daily may be required for most children of Asian origin to reach the therapeutic target.
Journal: International Journal of Antimicrobial Agents - Volume 49, Issue 4, April 2017, Pages 483-487