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Optimizing Voriconazole Dosing in Extremely Premature Infants With Aspergillus Infections

Adam Lee1,2, M Tuan Tran1,3, Jasjit Singh1,2

  • 1From the Department of Infectious Diseases, Children's Hospital of Orange County, Orange.

The Pediatric Infectious Disease Journal
|May 29, 2025
PubMed
Abstract

Insights

Frequent intravenous voriconazole dosing (every 8 hours) safely achieved therapeutic drug targets in premature infants with cutaneous aspergillosis. Oral voriconazole failed to reach target concentrations.

Area of Science:

  • Neonatal Medicine
  • Pediatric Infectious Diseases
  • Dermatology

Background:

  • Primary cutaneous aspergillosis is a serious concern in premature infants.
  • Standard voriconazole dosing (every 12 hours) often fails to reach therapeutic levels.
  • Optimizing voriconazole therapy is crucial for treating invasive fungal infections in neonates.

Purpose of the Study:

  • To evaluate the safety and efficacy of an every-8-hour intravenous voriconazole regimen.
  • To assess the attainment of therapeutic voriconazole drug targets in extremely premature infants.
  • To compare intravenous and enteral voriconazole administration for achieving therapeutic concentrations.

Main Methods:

  • Retrospective review of 4 extremely premature infants with primary cutaneous aspergillosis.
  • Administration of voriconazole every 8 hours with intensive therapeutic drug monitoring.
  • Analysis of demographics, treatment duration, debridement needs, and patient outcomes.

Main Results:

  • All infants survived with complete skin healing.
  • Intravenous voriconazole at 8-hour intervals achieved target trough concentrations (1-5 mcg/mL) in 69% of samples.
  • Enteral voriconazole consistently failed to reach therapeutic concentrations.
  • Minimal, transient adverse effects were observed.

Conclusions:

  • Intravenous voriconazole dosed every 8 hours is a safe and effective strategy for treating cutaneous aspergillosis in premature infants.
  • This optimized dosing regimen reliably achieves therapeutic drug targets.
  • Enteral voriconazole administration is inadequate for achieving therapeutic concentrations in this population.
Keywords:
aspergillosisfungalprematurevoriconazole

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