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Paediatric ganciclovir dosing in extracorporeal membrane oxygenation: Is standard dosing good enough?

Mark Murphy1, Andrea Chamberlain2, Peter Tang3

  • 1Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.

Journal of Clinical Pharmacy and Therapeutics
|September 24, 2019
PubMed

Insights

Standard ganciclovir dosing is ineffective for treating cytomegalovirus in patients on extracorporeal membrane oxygenation (ECMO). Higher doses may be needed to achieve therapeutic drug levels and control CMV viral load in these critically ill patients.

Area of Science:

  • Pharmacology
  • Critical Care Medicine
  • Infectious Diseases

Background:

  • Ganciclovir is a primary antiviral for cytomegalovirus (CMV) in immunocompromised individuals.
  • Ganciclovir pharmacokinetics are not established in patients undergoing extracorporeal membrane oxygenation (ECMO).

Observation:

  • A pediatric patient with advanced rhabdoid tumor experienced respiratory failure requiring ECMO.
  • Despite ganciclovir treatment, the patient exhibited rising CMV DNAemia.

Findings:

  • This case report details the first assessment of ganciclovir pharmacokinetics in a pediatric ECMO patient.
  • The standard recommended ganciclovir dosage resulted in a subtherapeutic area under the concentration-time curve (AUC24), correlating with increased CMV viral load.

Implications:

  • Current ganciclovir dosing may be insufficient for ECMO patients.
  • Increased ganciclovir doses might be necessary, particularly in ECMO patients not receiving continuous renal replacement therapy (CRRT).
  • Further research is warranted to optimize ganciclovir dosing strategies in ECMO populations.
Abstract

Keywords:
clinical pharmacokineticsclinical pharmacyclinicianspharmacistspharmacodynamicspharmacokineticstherapeutic drug monitoring

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