Optimizing Voriconazole Dosing in Extremely Premature Infants With Aspergillus Infections

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.