Voriconazole: Poor Oral Bioavailability and Possible Renal Toxicity in an Infant With Invasive Aspergillosis

Area of Science:

• Pediatric Infectious Diseases
• Clinical Pharmacology
• Mycology

Background:

• Invasive aspergillosis requires effective antifungal therapy, with voriconazole as a primary treatment option.
• Challenges exist in achieving therapeutic voriconazole serum concentrations and managing toxicity in infants.
• Pediatric dosing requires careful consideration due to pharmacokinetic variations.

Observation:

• A case of invasive aspergillosis in an infant treated with intravenous voriconazole is presented.
• The infant developed renal toxicity, suspected to be associated with intravenous voriconazole administration.
• Renal function improved after discontinuing the intravenous formulation and switching to oral voriconazole.

Findings:

• The infant required high, weight-based oral voriconazole doses to reach therapeutic serum concentrations.
• This case suggests a rare renal side effect of voriconazole in infants.
• Significant challenges in voriconazole pharmacokinetics were observed in this pediatric patient.

Implications:

• This case underscores the need for vigilant monitoring of renal function in infants receiving voriconazole.
• It highlights the complexities of voriconazole dosing and formulation selection in pediatric patients.
• Further research into optimal voriconazole dosing strategies for infants is warranted.