Voriconazole plasma levels in children are highly variable

Excerpt

Voriconazole is widely used as first-line agent to treat invasive aspergillosis in immunocompromised adults. Also in children, its use is increasing [1]. During the last decade, several studies in adults demonstrated a pharmacodynamic relationship between low voriconazole levels and lack of response, and high voriconazole levels and toxicity [2, 3]. However, voriconazole has very complex pharmacokinetics resulting in highly variable plasma levels. As a result, it is recommended to monitor voriconazole plasma levels in adult patients with uncontrolled infection, gastro-intestinal dysfunction, severe hepatic dysfunction, and unexplained neurological symptoms. Target trough levels should be higher than 1 or 2 mg/L to guarantee efficacy and lower than 6 mg/L to avoid toxicity [2, 3]. …