Related Experiment Video

Updated: Aug 13, 2026

Quantification of the Immunosuppressant Tacrolimus on Dried Blood Spots Using LC-MS/MS
08:38

Quantification of the Immunosuppressant Tacrolimus on Dried Blood Spots Using LC-MS/MS

Published on: November 8, 2015

Optimizing Posaconazole Suspension Prophylaxis in Pediatric Patients: The Key Role of Therapeutic Drug Monitoring

Maria Álvarez de Toledo1,2, Maria Blanca Guembe Zabaleta3, Laura Barenblit-Mas1

  • 1From the Paediatric Infectious Diseases and Immunodeficiencies Unit, Children's Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Catalonia, Spain.

The Pediatric Infectious Disease Journal
|August 12, 2026
PubMed

Insights

Therapeutic drug monitoring (TDM) of posaconazole suspension is crucial in children to ensure effective prophylaxis against invasive fungal infections. Nearly half of pediatric patients had subtherapeutic posaconazole levels, highlighting the need for TDM and dose adjustments.

Area of Science:

  • Pediatric Pharmacology
  • Infectious Diseases
  • Clinical Pharmacy

Background:

  • Posaconazole suspension is vital for preventing invasive fungal infections in high-risk children.
  • Its use is limited by low bioavailability and variable pharmacokinetics, necessitating therapeutic drug monitoring (TDM).

Purpose of the Study:

  • To assess TDM effectiveness for prophylactic posaconazole suspension in pediatric patients.
  • To identify factors influencing posaconazole pharmacokinetics in children.

Main Methods:

  • Retrospective observational study (2017-2023) of pediatric patients (<18 years) on posaconazole prophylaxis.
  • Analysis included serum posaconazole trough concentrations (Ctrough) and clinical data.

Main Results:

  • Nearly half (50.1%) of 373 Ctrough measurements were subtherapeutic.
  • Younger children (<2 years) received higher doses (17.4 mg/kg/day).
  • Nausea/vomiting and proton pump inhibitor use were linked to subtherapeutic levels.

Conclusions:

  • TDM is essential for optimizing posaconazole therapy in pediatric patients.
  • Children under 2 may require doses of at least 15 mg/kg/day.
  • Risk factors for subtherapeutic levels should guide TDM frequency.
Abstract

Keywords:
childrenimmunocompromisedpharmacokineticsposaconazoleprophylaxis

Related Concept Videos

Pharmacokinetics in Pediatric Patients: Drug Excretion01:26

Pharmacokinetics in Pediatric Patients: Drug Excretion

In pediatric medicine, understanding the renal function and drug elimination nuances is crucial for administering safe and effective treatments. Newborns, in particular, display markedly slower renal functions than adults, profoundly affecting how drugs are cleared from their bodies. This slower drug clearance requires clinicians to extend the dosing intervals for many medications to prevent drug accumulation and toxicity while ensuring therapeutic efficacy.One key area where these adjustments...
Therapeutic Drug Monitoring: Overview and Classification01:16

Therapeutic Drug Monitoring: Overview and Classification

Therapeutic Drug Monitoring (TDM) is a clinical practice that measures specific drug levels in a patient's blood at designated intervals to ensure the drug concentration stays within a therapeutic range. This monitoring is crucial for optimizing individual dosage regimens, enhancing therapeutic efficacy, and minimizing drug-related toxicity. TDM is vital for drugs with narrow therapeutic windows, significant variability in pharmacokinetics, and a clear correlation between plasma levels and...
Therapeutic Drug Monitoring: Affecting Factors01:29

Therapeutic Drug Monitoring: Affecting Factors

Therapeutic Drug Monitoring (TDM) is the clinical practice of measuring specific drug levels in a patient's blood or body tissues to manage and optimize therapy. TDM is crucial for drugs with narrow therapeutic windows, like warfarin and phenytoin, where incorrect doses can lead to treatment failure or severe side effects. This monitoring ensures the dosage administered is within a safe and effective range. The factors affecting therapeutic drug monitoring include:Patient-Specific Factors:a.
Pharmacokinetics in Pediatric Patients: Drug Metabolism01:24

Pharmacokinetics in Pediatric Patients: Drug Metabolism

In pediatric care, understanding the nuances of hepatic drug metabolism is crucial, as it significantly differs from that of adults. This divergence is primarily due to the developmental stage of drug-metabolizing enzymes, which affects how medications are processed in the body. In neonates, for instance, the activity of Phase I enzymes—critical for the initial breakdown of drugs—is markedly reduced, functioning at just 20–40% of the levels seen in adults. This reduction poses a challenge in...
Therapeutic Drug Monitoring: Drug Analysis Methods01:26

Therapeutic Drug Monitoring: Drug Analysis Methods

Therapeutic Drug Monitoring (TDM) is a clinical practice that measures specific drug levels in a patient's blood or body tissues to tailor drug therapy effectively. This monitoring is critical for managing drugs with narrow therapeutic indices like digoxin and phenytoin, ensuring they are both safe and effective. For instance, monitoring theophylline levels in asthma patients involves precision and sensitivity to adjust doses according to individual responses to therapy, ensuring efficacy and...
Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption01:23

Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption

Understanding the physiological differences in the pediatric population is crucial for effective pharmacotherapy. Neonates, infants, and children exhibit significant variations in gastric pH, gastric emptying time, intestinal transit time, and biliary function. These variations profoundly affect oral drug absorption, necessitating a nuanced approach to pediatric dosing.Neonates present with a unique physiological profile, having a gastric pH greater than 4 and faster and more irregular gastric...