2026-04-13T04:17:49Zhttps://recercat.cat/oai/request

oai:recercat.cat:11351/71012025-10-24T10:39:35Zcom_2072_378070com_2072_378040col_2072_378092

Voriconazole Use in Children: Therapeutic Drug Monitoring and Control of Inflammation as Key Points for Optimal Treatment Valle-T-Figueras, Jose María Renedo Miro, Berta Díaz de Heredia Rubio, Maria Cristina Vima Bofarull, Jaume Mendoza Palomar, Natalia Ana Martin Gomez, M Teresa Soler Palacín, Pere Benitez Carabante, Maria Isabel Institut Català de la Salut [Valle-T-Figueras JM] Unitat de Patologia Infecciosa i Immunodeficiències de Pediatria, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra, Spain. Department of Paediatrics, Hospital Universitari de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Bellaterra, Spain. [Renedo Miró B] Servei de Farmàcia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. [Benítez Carabante MI, Díaz-de-Heredia C] Servei d’Oncologia i Hematologia Pediàtriques, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra, Spain. [Vima Bofarull J] Servei de Bioquímica Clínica, Laboratoris Clínics Centrals, Vall d’Hebron Hospital Universitari, Barcelona, Spain. [Mendoza-Palomar N, Soler-Palacín P] Unitat de Patologia Infecciosa i Immunodeficiències de Pediatria, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra, Spain. [Martín-Gómez MT] Servei de Microbiologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra, Spain Vall d'Hebron Barcelona Hospital Campus Medicaments antifúngics - Ús terapèutic Posologia Malalties transmissibles - Tractament ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Diagnosis::Prognosis::Treatment Outcome CHEMICALS AND DRUGS::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Anti-Infective Agents::Antifungal Agents Other subheadings::Other subheadings::Other subheadings::/administration & dosage DISEASES::Bacterial Infections and Mycoses::Infection::Communicable Diseases TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::diagnóstico::pronóstico::resultado del tratamiento COMPUESTOS QUÍMICOS Y DROGAS::acciones y usos químicos::acciones farmacológicas::usos terapéuticos::antiinfecciosos::antifúngicos Otros calificadores::Otros calificadores::Otros calificadores::/administración & dosificación ENFERMEDADES::infecciones bacterianas y micosis::infección::enfermedades transmisibles Infeccions fúngiques pediàtriques; Monitorització terapèutica de fàrmacs; Voriconazol Infecciones fúngicas pediátricas; Monitorización terapéutica de fármacos; Voriconazol Paediatric fungal infections; Therapeutic drug monitoring; Voriconazole Voriconazole plasma concentrations (PC) are highly variable, particularly in children. Dose recommendations in 2–12-year-old patients changed in 2012. Little data on therapeutic drug monitoring (TDM) after these new recommendations are available. We aimed to evaluate voriconazole monitoring in children with invasive fungal infection (IFI) after implementation of new dosages and its relationship with safety and effectiveness. A prospective, observational study, including children aged 2–12 years, was conducted. TDM was performed weekly and doses were changed according to an in-house protocol. Effectiveness, adverse events, and factors influencing PC were analysed. A total of 229 PC from 28 IFI episodes were obtained. New dosing led to a higher rate of adequate PC compared to previous studies; still, 35.8% were outside the therapeutic range. In patients aged < 8 years, doses to achieve therapeutic levels were higher than recommended. Severe hypoalbuminemia and markedly elevated C-reactive protein were related to inadequate PC. Therapeutic PC were associated with drug effectiveness and safety. Higher doses in younger patients and a dose adjustment protocol based on TDM should be considered. Voriconazole PC variability has decreased with current updated recommendations, but it remains high and is influenced by inflammatory status. Additional efforts to control inflammation in children with IFI should be encouraged. This research was funded by an Investigator Sponsored Research Grant from Pfizer (Grant Number WI182544) 2022-03-01T07:31:13Z 2022-03-01T07:31:13Z 2021-06 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion Valle-T-Figueras JM, Renedo Miró B, Benítez Carabante MI, Díaz-de-Heredia C, Vima Bofarull J, Mendoza-Palomar N, et al. Voriconazole Use in Children: Therapeutic Drug Monitoring and Control of Inflammation as Key Points for Optimal Treatment. J Fungi. 2021 Jun;7(6):456. 2309-608X https://hdl.handle.net/11351/7101 10.3390/jof7060456 34200506 000666633900001 http://hdl.handle.net/11351/7101 eng Journal of Fungi;7(6) https://doi.org/10.3390/jof7060456 Attribution 4.0 International http://creativecommons.org/licenses/by/4.0/ info:eu-repo/semantics/openAccess application/pdf MDPI Scientia