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Published on: November 8, 2015

Ganciclovir Therapeutic Drug Monitoring in Critically Ill Pediatric Patients Receiving Continuous Renal Replacement

Christina J Smith1, Laura J Walsh1, Kyle R Roberts1

  • 1Department of Pharmacy (CJS, LJW, KR, SVK), Seattle Children's Hospital, Seattle, WA.

The Journal of Pediatric Pharmacology and Therapeutics : JPPT : the Official Journal of PPAG
|June 10, 2026
PubMed

Insights

Ganciclovir dosing in children on continuous renal replacement therapy (CRRT) is not well-established. A dose of 2.5 mg/kg every 12 hours showed potential for achieving target ganciclovir exposure in this critical care setting.

Area of Science:

  • Pediatric Critical Care Medicine
  • Pharmacokinetics and Drug Metabolism
  • Infectious Diseases

Background:

  • Ganciclovir dosing for cytomegalovirus and herpesvirus infections in pediatric patients on continuous renal replacement therapy (CRRT) remains undefined.
  • Existing pediatric ganciclovir pharmacokinetic (PK) data indicate significant interpatient variability and a risk of sub-therapeutic drug levels.
  • Therapeutic drug monitoring (TDM) is suggested for optimizing ganciclovir dosing in pediatric patients, targeting a 24-hour area under the curve (AUC24) of 80-120 mg·hr/L.

Purpose of the Study:

  • To evaluate ganciclovir dosing strategies and pharmacokinetic profiles in critically ill pediatric patients undergoing CRRT.
  • To assess the variability in ganciclovir exposure among pediatric patients requiring CRRT.
  • To investigate the potential for optimizing ganciclovir therapy through TDM in this specific patient population.

Main Methods:

  • A retrospective, single-center cohort study was conducted.
  • Electronic medical records of pediatric patients (≤17 years) receiving ganciclovir and drug monitoring in the PICU (July 2022-July 2023) were reviewed.
  • Data collected included ganciclovir dose, PK parameters, CRRT modality, and clinical outcomes.

Main Results:

  • Five pediatric patients (median age, 12 years) received ganciclovir during the study period.
  • Patients underwent continuous venovenous hemodiafiltration with a median clearance of 1928 mL/1.73m²/hr.
  • A ganciclovir dose of 2.5 mg/kg every 12 hours was most frequently associated with achieving the target AUC24 of 80-120 mg·hr/L.

Conclusions:

  • Ganciclovir drug exposure is highly variable in critically ill pediatric patients receiving CRRT.
  • Further research is necessary to establish optimal ganciclovir dosing regimens for this population.
  • The precise role of TDM in guiding ganciclovir therapy for pediatric CRRT patients requires additional investigation.
Abstract

Keywords:
childrencytomegalovirusdrug monitoringganciclovirrenal replacement therapy

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