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Voriconazole plasma monitoring
  1. Alessandro C Pasqualotto (acpasqualotto{at}hotmail.com)
  1. The University of Manchester, United Kingdom
    1. Mamta Shah (mamta.shah{at}cmmc.nhs.uk)
    1. Burn Unit, Booth Hall Children's Hospital, Manchester, United Kingdom
      1. Robert Wynn (robert.wynn{at}cmmc.nhs.uk)
      1. Department of Haematology, Royal Manchester Children's Hospital, Pendlebury, Manchester, United Kingdom
        1. David W Denning (ddenning{at}manchester.ac.uk)
        1. The University of Manchester, United Kingdom

          Abstract

          Aims: 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 5 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 bioassay or liquid chromatography-tandem mass spectrometry.

          Results: The patients' ages ranged from 2-10 years-old (mean 6.2 years-old). Three patients had acute leukaemia and 2 suffered severe burn injuries. Doses administered varied from 3.4 mg/kg every 12 hours to 8.1 mg/kg every 8 hours. 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 2 of the patients.

          Conclusions: Dose administered did not correlate with exposure as measured by plasma levels of voriconazole. Whilst 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.

          • antifungal drugs
          • aspergillosis
          • children
          • drug monitoring
          • voriconazole

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          • erratum 93/7/578

            Erratum from the authors

            We mention in the abstract that 'Phenobarbitone caused important drug interactions with voriconazole for 2 of the patients'. Actually that occurred for only one patient, so the correct sentence would be 'Phenobarbitone caused important drug interactions with voriconazole for one of the patients'.

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              BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health