Valenzuela Romina, García Patricio, Barraza Marlon, Palma Julia, Catalán Paula, Santolaya M Elena, Torres J Pablo, Morales Jorge
Departamento de Pediatría y Cirugía Infantil Oriente, Unidad de Investigación, Facultad de Medicina, Hospital Dr. Luis Calvo Mackenna, Universidad de Chile, Santiago, Chile.
Unidad de Farmacia, Hospital Dr. Luis Calvo Mackenna, Santiago, Chile.
Rev Chilena Infectol. 2018;35(1):15-21. doi: 10.4067/s0716-10182018000100015.
Background There is no consensus on the optimal dosage use of posaconazole (PSC) for invasive fungal infection (IFI) in pediatric patients and normally it is adjusted with drug levels (DLs) ≥ 0.7 μg/ml and ≥ 1.25 μg/ml for prophylaxis and treatment, respectively. Objective To describe the experience of monitoring DLs of PSC in immunocompromised pediatric patients with IFI and to determine if the recommended doses reach CP effective in prophylaxis (≥ 0.7 μg/mL) and treatment (≥ 1.25 μg/mL). Method A retrospective analysis in children who received PSC from January 2012 to October 2016, in the Oncology and Bone Marrow Transplant units at Hospital Calvo Mackenna was done Six patients with 78 DLs were reviewed (4 prophylaxis and 4 treatment). Median PSC dose was 12.5 and 18.8 mg/kg/d for prophylaxis and treatment, resulting in mean DLs of 0.97 and 1.8 μg/mL respectively. In prophylaxis 40/67 (60%) were recorded with DLs ≥ 0.70 μg/mL receiving a median dose of 12.5 mg/kg/d. While for treatment: 5/11 (46%) presented DLs ≥ 1.25 μg/mL, receiving a median dose of 18 mg/kg/d. Conclusion Our results are in line with the recommended for PSC dosage, but individualized monitoring is required to maintain adequate DLs.
对于儿科患者侵袭性真菌感染（IFI），泊沙康唑（PSC）的最佳剂量使用尚无共识，通常分别根据预防和治疗时药物水平（DLs）≥0.7μg/ml和≥1.25μg/ml进行调整。目的：描述监测免疫功能低下的儿科IFI患者PSC药物水平的经验，并确定推荐剂量是否能达到预防（≥0.7μg/mL）和治疗（≥1.25μg/mL）的有效血药浓度。方法：对2012年1月至2016年10月在卡尔沃·麦肯纳医院肿瘤学和骨髓移植科接受PSC治疗的儿童进行回顾性分析。共审查了6例患者的78次药物水平（4例预防和4例治疗）。预防和治疗时PSC的中位剂量分别为12.5和18.8mg/kg/d，平均药物水平分别为0.97和1.8μg/mL。在预防中，67次中有40次（60%）记录到药物水平≥0.70μg/mL，中位剂量为12.5mg/kg/d。而在治疗中：11次中有5次（46%）药物水平≥1.25μg/mL，中位剂量为18mg/kg/d。结论：我们的结果与PSC的推荐剂量一致，但需要进行个体化监测以维持足够的药物水平。
