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Isavuconazole in Pediatric Invasive Fungal Infections: Outcomes and Therapeutic Drug Monitoring in a Chinese

Shupeng Zou1, Chang Shu2, Xiaolin Liang3

  • 1Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China.

Infection and Drug Resistance
|April 20, 2026
PubMed
Abstract

Insights

Isavuconazole (ISA) shows excellent efficacy and tolerability for pediatric invasive fungal infections (IFIs) in China. Routine therapeutic drug monitoring and pharmacist stewardship optimize ISA treatment outcomes in children.

Area of Science:

  • Pediatric infectious diseases
  • Pharmacology and pharmacotherapy
  • Antifungal drug efficacy

Background:

  • Limited real-world data exists on isavuconazole (ISA) efficacy for pediatric invasive fungal infections (IFIs), especially in Asian populations.
  • This study addresses the scarcity of evidence by evaluating ISA in a Chinese pediatric cohort.

Purpose of the Study:

  • To assess the efficacy and tolerability of isavuconazole (ISA) in pediatric patients with invasive fungal infections (IFIs) in China.
  • To evaluate the impact of therapeutic drug monitoring (TDM) and clinical pharmacist stewardship on ISA treatment outcomes.

Main Methods:

  • A retrospective, multicenter observational study of children (aged 1-17 years) with IFIs treated with ISA for ≥7 days in central China.
  • Therapeutic drug monitoring (TDM) using LC-MS/MS targeted trough concentrations (Ctrough) of 2-4 mg/L, with weekly antifungal stewardship interventions by clinical pharmacists.

Main Results:

  • Ten pediatric patients received ISA, with 80% used as salvage therapy. Median treatment duration was 43.5 days.
  • Initial median Ctrough was subtherapeutic (1.7 mg/L) in 60% of patients; pharmacist-led dose escalation achieved target attainment in 83% of adjusted cases.
  • A favorable response rate of 80% was observed by day 42, with no QTc prolongation or severe hepatotoxicity. Median estimated AUC0-24/MIC strongly predicted mold infection success.

Conclusions:

  • This is the first Chinese multicenter pediatric series demonstrating isavuconazole's (ISA) excellent efficacy and tolerability.
  • Routine therapeutic drug monitoring (TDM) and clinical pharmacist stewardship are crucial for optimizing ISA treatment in pediatric IFIs.
  • Further validation is needed due to the study's small sample size.
Keywords:
antifungal stewardshipinvasive fungal infectionisavuconazolepediatricreal-world evidencetherapeutic drug monitoring

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