Intravenous voriconazole therapy in a preterm infant

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Intravenous Injections in Neonatal Mice
05:17

Intravenous Injections in Neonatal Mice

Published on: November 11, 2014

Kendre'a M Muldrew1, Holly D Maples, Cindy D Stowe

  • 1Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.

Pharmacotherapy
|June 2, 2005
PubMed

Insights

A preterm infant with fluconazole-resistant Candida infection received voriconazole treatment. Higher doses achieved therapeutic serum concentrations, resolving the infection safely alongside phenobarbital.

Area of Science:

  • Neonatal Medicine
  • Infectious Diseases
  • Pharmacology

Background:

  • Disseminated fluconazole-resistant Candida albicans infections pose a significant challenge in preterm infants.
  • Standard antifungal treatment regimens may require adjustments in neonates due to altered pharmacokinetics.

Observation:

  • A preterm infant presented with a severe Candida albicans infection resistant to fluconazole.
  • Initial treatment with liposomal amphotericin B was followed by combination therapy including intravenous voriconazole.
  • Concomitant phenobarbital therapy was administered throughout the infant's hospitalization.

Findings:

  • Initial high-dose intravenous voriconazole (6 mg/kg every 12 hours) resulted in sub-therapeutic serum concentrations in the infant.
  • Increasing the voriconazole dosage to 6 mg/kg every 8 hours achieved therapeutic serum concentrations comparable to adult levels.
  • The infection resolved following the dose escalation of voriconazole, and the regimen was safely tolerated with phenobarbital.

Implications:

  • Optimized dosing of intravenous voriconazole is crucial for achieving therapeutic efficacy in preterm infants with invasive fungal infections.
  • Pharmacokinetic considerations, including developmental changes in drug metabolism and excretion, must guide voriconazole dosing in neonates.
  • This case highlights the successful use of adjusted-dose voriconazole in treating resistant fungal infections in a vulnerable preterm population.

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