Neely Michael, Blumer Jeffrey
Division of Pediatric Infectious Diseases and.
Division of Pediatric Critical Care and Pharmacology, Rainbow Babies and Children's Hospital, University Hospitals of Cleveland, Cleveland, Ohio, USA.
Curr Ther Res Clin Exp. 2003 Feb;64(2):127-36. doi: 10.1016/S0011-393X(03)00019-5.
The pharmacokinetic characteristics of the antifungal drug caspofungin have not been reported in children.
The aim of this study was to report limited caspofungin pharmacokinetic data for pediatric liver transplant patients.
Two pediatric liver transplant patients, aged 5 years (not dialyzed) and 9 months (dialyzed), were assessed. Using a novel, validated, liquid-phase extraction with high-performance liquid chromatography, we measured plasma caspofungin concentrations from blood samples obtained within a 24-hour period after the patients were given 1 mg/kg IV of caspofungin.
Noncompartmental analysis for the nondialyzed patient showed an elimination half-life of 10.7 hours, a volume of distribution of 0.11 L/kg, and a systemic clearance of 0.12 mL/min/kg. Liver enzyme activities increased briefly; the increase may have been due to concomitant graft rejection. For the dialyzed patient, the half-life was 11.7 hours, with an adjusted volume of distribution of 0.18 L/kg and a systemic clearance of 0.24 mL/min/kg. No clinically relevant treatment-related adverse events were noted.
Pharmacokinetic data found in the 2 patients in this study are similar to those reported in adults. Until more thorough data are published, caspofungin 1 mg/kg may be considered a reasonable, tolerable dose for children.
抗真菌药物卡泊芬净的药代动力学特征在儿童中尚未见报道。
本研究旨在报告小儿肝移植患者有限的卡泊芬净药代动力学数据。
评估了两名小儿肝移植患者，分别为5岁（未透析）和9个月大（透析）。采用一种新型的、经过验证的高效液相色谱法液相萃取技术，我们在患者静脉注射1mg/kg卡泊芬净后24小时内采集血样，测定血浆卡泊芬净浓度。
对未透析患者的非房室分析显示，消除半衰期为10.7小时，分布容积为0.11L/kg，全身清除率为0.12mL/min/kg。肝酶活性短暂升高；这种升高可能是由于同时发生的移植物排斥反应。对于透析患者，半衰期为11.7小时，调整后的分布容积为0.18L/kg，全身清除率为0.24mL/min/kg。未观察到与治疗相关的临床相关不良事件。
本研究中2名患者的药代动力学数据与成人报道的数据相似。在有更全面的数据公布之前，卡泊芬净1mg/kg可被认为是儿童合理、可耐受的剂量。
