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Whole Genome Sequencing of Candida glabrata for Detection of Markers of Antifungal Drug Resistance
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Voriconazole Treatment for an Infant With Intractable Candida glabrata Meningitis

Sophia Tsakiri1, Chiamaka Aneji1, Christine Domonoske2

  • 1From the Department of Pediatrics, University of Texas Health.

The Pediatric Infectious Disease Journal
|April 21, 2018
PubMed

Insights

High voriconazole levels were observed in an infant with disseminated Candida glabrata infection. Despite dose reduction, drug levels remained elevated without causing toxicity, indicating potential pharmacokinetic challenges in infant antifungal treatment.

Area of Science:

  • Medical Mycology
  • Pediatric Pharmacology
  • Infectious Diseases

Background:

  • Disseminated Candida glabrata infections pose a significant challenge in infants.
  • Voriconazole is a critical antifungal agent for invasive Candida infections.
  • Optimizing voriconazole dosing in neonates and infants is crucial due to altered pharmacokinetics.

Observation:

  • This case study monitored voriconazole levels in an infant receiving combination therapy and rescue voriconazole.
  • Serum and cerebrospinal fluid (CSF) voriconazole concentrations were measured.
  • The infant had a disseminated Candida glabrata infection.

Findings:

  • Voriconazole levels in both serum and CSF were unexpectedly high, exceeding target therapeutic ranges.
  • A reduction in the voriconazole dose did not result in a corresponding decrease in blood or CSF levels.
  • No identifiable drug toxicity was observed in the infant despite the elevated drug concentrations.

Implications:

  • These findings suggest potential pharmacokinetic variability or reduced clearance of voriconazole in infants with disseminated fungal infections.
  • The data highlight the need for careful therapeutic drug monitoring of voriconazole in pediatric populations.
  • Further research into optimal voriconazole dosing strategies and potential drug interactions in infants is warranted.

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