Related Experiment Video
Updated: Jul 7, 2026
Live Imaging of Antifungal Activity by Human Primary Neutrophils and Monocytes in Response to A. fumigatus
Published on: April 19, 2017
Voriconazole plasma monitoring
A C Pasqualotto1, M Shah, R Wynn
1Alessandro Pasqualotto, Education and Research Centre, Wythenshawe Hospital, Southmoor Road, Manchester, M23 9LT, UK. acpasqualotto@hotmail.com
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 five 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 a bioassay or liquid chromatography-tandem mass spectrometry.
Results:
The patients' ages ranged from 2 to 10 years old (mean 6.2 years). Three patients had acute leukaemia and two had suffered severe burn injuries. Doses administered varied from 3.4 mg/kg every 12 h to 8.1 mg/kg every 8 h. 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 one [corrected] of the patients.
Conclusions:
The dose administered did not correlate with exposure as measured by plasma levels of voriconazole. While 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.
Insights
Drug monitoring of voriconazole is crucial in children with invasive fungal infections. Plasma levels were unpredictable, showing subtherapeutic or excessive concentrations, highlighting the need for careful monitoring and dose adjustments.
Area of Science:
- Pharmacology
- Pediatric Medicine
- Infectious Diseases
Background:
- Limited data exists on voriconazole drug monitoring in pediatric patients.
- Invasive fungal infections pose significant risks in immunocompromised children.
Purpose of the Study:
- To report on therapeutic drug monitoring of voriconazole in five pediatric patients.
- To assess the relationship between voriconazole dosage and plasma concentrations in children.
Main Methods:
- Case series of five pediatric patients treated with voriconazole.
- Voriconazole plasma levels measured by bioassay or liquid chromatography-tandem mass spectrometry.
Main Results:
- Patient ages ranged from 2 to 10 years; conditions included acute leukemia and severe burns.
- Voriconazole plasma concentrations were unpredictable, with frequent subtherapeutic levels and occasional excessive levels.
- Phenobarbitone was identified as a significant drug interaction affecting voriconazole exposure.
Conclusions:
- Voriconazole dosage did not reliably correlate with plasma exposure in pediatric patients.
- Therapeutic drug monitoring is essential to ensure adequate voriconazole exposure and prevent toxicity in children.
- Drug interactions can significantly impact voriconazole levels, necessitating vigilant monitoring.
Related Concept Videos
01:29Therapeutic Drug Monitoring: Affecting Factors
01:26Therapeutic Drug Monitoring: Drug Analysis Methods
01:29Drug Distribution: Plasma Protein Binding
01:18Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
01:15Drug Concentration Versus Time Correlation
Two pivotal parameters are the minimum effective concentration (MEC) and the minimum toxic concentration (MTC). The MEC is the lowest drug...
01:01Dosage Regimens: Partial Pharmacokinetic Parameters