Navigating Voriconazole in Pediatrics: Dosing Dilemmas and Monitoring Madness

Area of Science:

• Pediatric Pharmacology
• Antifungal Drug Therapy
• Clinical Pharmacy Practice

Background:

• Voriconazole (VOR) use in children requires therapeutic drug monitoring (TDM) due to significant pharmacokinetic variability.
• Suboptimal VOR TDM practices were identified, necessitating improvements for safe and effective patient care.
• Achieving trough concentrations at steady state (tr_ss) is critical for optimizing VOR efficacy and minimizing toxicity.

Purpose of the Study:

• To enhance the proportion of VOR TDM samples collected as tr_ss in pediatric patients.
• To implement targeted interventions to improve VOR TDM practices.
• To establish a foundation for future improvements in achieving timely therapeutic VOR tr_ss.

Main Methods:

• Internal audit of existing VOR TDM procedures.
• Revision of the laboratory ordering system for VOR TDM.
• Development and dissemination of a comprehensive triazole TDM guidance document.

Main Results:

• The implemented interventions led to a statistically significant increase in the proportion of VOR TDM obtained as tr_ss.
• The revised lab order facilitated more accurate sample timing.
• The guidance document improved clinician adherence to optimal TDM protocols.

Conclusions:

• Targeted interventions, including lab order revisions and educational guidance, can effectively improve VOR TDM practices in pediatric populations.
• Increasing the proportion of VOR tr_ss is an achievable goal with practical implementation strategies.
• These improvements represent a crucial initial step towards optimizing VOR therapy and patient outcomes in children.