Isavuconazole use and TDM in real-world pediatric practice

Area of Science:

• Pediatric Infectious Diseases
• Clinical Pharmacology

Background:

• Isavuconazole (ISA) is approved for adults with invasive fungal infections but is used off-label in pediatric patients.
• Invasive fungal infections pose significant risks to children, necessitating effective treatment strategies.

Purpose of the Study:

• To evaluate the real-world use of Isavuconazole in pediatric patients with invasive fungal infections.
• To assess the necessity and impact of therapeutic drug monitoring (TDM) for Isavuconazole in children.

Main Methods:

• Retrospective analysis of 15 pediatric patients treated with Isavuconazole.
• Therapeutic drug monitoring (TDM) including C_trough levels was performed for all patients.
• Analysis of TDM results, particularly in patients on extracorporeal membrane oxygenation (ECMO).

Main Results:

• Isavuconazole was administered to 15 pediatric patients for invasive fungal infections.
• Therapeutic drug monitoring revealed that 46.8% (52/111) of C_trough determinations were outside the target range.
• A higher proportion of out-of-range levels were observed in patients receiving ECMO.

Conclusions:

• Real-world data support the use of Isavuconazole in pediatric invasive fungal infections.
• Therapeutic drug monitoring is crucial for optimizing Isavuconazole dosing in children.
• TDM is particularly important for pediatric patients on ECMO due to altered pharmacokinetics.