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Clinical application of voriconazole in pediatric patients: a systematic review

Lin Hu1,2, Juanjuan Huang3,4, Yanfei Li3,4

  • 1Department of Pharmacy, The Affiliated Changsha Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China. 1150721071@qq.com.

Italian Journal of Pediatrics
|June 9, 2024
PubMed

Insights

This review found that voriconazole (VRC) dosing in children is affected by age and other factors. Establishing a population pharmacokinetic (PPK) model can help optimize VRC therapy for pediatric patients.

Area of Science:

  • Pharmacology and Therapeutics
  • Pediatric Medicine
  • Clinical Pharmacy

Background:

  • Voriconazole (VRC) is a critical antifungal agent used in pediatric populations.
  • Optimizing VRC therapy in children is essential due to its narrow therapeutic index and potential for toxicity.
  • Understanding factors influencing VRC pharmacokinetics in pediatric patients is crucial for effective treatment.

Approach:

  • A systematic literature review was conducted using major biomedical databases (MEDLINE, Embase, PubMed, Web of Science, Cochrane Library) from January 2000 to August 2023.
  • Included 35 observational studies focusing on VRC use in pediatric patients, analyzing factors affecting plasma trough concentrations (Ctrough), required maintenance doses, and population pharmacokinetic (PPK) data.
  • Data extraction and synthesis were performed based on predefined inclusion and exclusion criteria.

Key Points:

  • Voriconazole (VRC) plasma trough concentrations (Ctrough) in pediatric patients are influenced by a combination of genetic and non-genetic factors.
  • Optimal VRC dosing is age-dependent, with younger children typically requiring higher doses than older children to reach therapeutic Ctrough levels.
  • Population pharmacokinetic (PPK) studies are vital for understanding VRC variability and guiding individualized dosing strategies in children.

Conclusions:

  • Individualized VRC dosing is necessary in pediatric patients to achieve target therapeutic concentrations and improve clinical outcomes.
  • The development and application of a VRC population pharmacokinetic (PPK) model can significantly enhance dosing precision in children.
  • Further research into VRC pharmacokinetics and pharmacodynamics in diverse pediatric populations is warranted to refine treatment guidelines.

Keywords:
FactorsOptimal dosePediatric patientsPlasma trough concentrationsVoriconazole

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