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Evaluation of Posaconazole Dosing in Children and Young Adults: A Single-Center Review

Lauren M Garner, Susan Ngo, Jenna Bognaski Kaplan

    The Journal of Pediatric Pharmacology and Therapeutics : JPPT : the Official Journal of PPAG
    |November 18, 2021
    PubMed

    Insights

    Many children do not reach target posaconazole concentrations with initial dosing. This study found only 55.5% of pediatric patients achieved desired levels, indicating a need for optimized posaconazole dosing strategies in pediatrics.

    Area of Science:

    • Pharmacology
    • Pediatric Medicine
    • Infectious Diseases

    Background:

    • Initial posaconazole dosing in children frequently fails to achieve target therapeutic concentrations.
    • Existing data suggest higher initial posaconazole doses may be necessary for pediatric populations.
    • Suboptimal dosing can impact treatment efficacy and patient outcomes.

    Purpose of the Study:

    • To retrospectively analyze posaconazole dosing strategies and resulting serum concentrations in pediatric patients.
    • To determine the proportion of pediatric patients achieving target posaconazole trough concentrations with initial regimens.
    • To evaluate breakthrough invasive fungal infections, liver function test elevations, and treatment discontinuation rates.

    Main Methods:

    • Retrospective study at a single institution involving 27 pediatric patients (1-21 years).
    • Inclusion criteria: initiation of any posaconazole formulation for prophylaxis or treatment during hospitalization.
    • Primary outcome: percentage of patients achieving target trough concentration; secondary outcomes: breakthrough invasive fungal infections (IFI), elevated liver function tests (LFTs), and discontinuation.

    Main Results:

    • 55.5% (15/27) of pediatric patients achieved target posaconazole trough concentrations with initial dosing.
    • Dose modifications were required for 1 to 3 instances to reach target levels.
    • Breakthrough IFI occurred in 7.4% (2/27) of patients; 18.5% (5/27) had elevated LFTs; 25.9% (7/27) discontinued treatment early.

    Conclusions:

    • The initial posaconazole dosing strategy resulted in 55% of pediatric patients achieving target trough concentrations.
    • These findings highlight the challenges in optimizing posaconazole dosing for pediatric patients.
    • Further research into higher or adjusted dosing regimens is warranted to improve therapeutic drug monitoring in children.
    Abstract

    Keywords:
    antifungalinvasive fungal infectionpediatricspharmacistposaconazoleyoung adults

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