Department of Pharmacy, Primary Children's Hospital, Salt Lake City, UT, USA.
Pharmaceutical Department, St. Jude Children's Research Hospital, Memphis, TN, USA.
J Antimicrob Chemother. 2020 Dec 1;75(12):3682-3687. doi: 10.1093/jac/dkaa377.
Posaconazole exhibits broad-spectrum antifungal activity. An IV formulation became available in 2014. Few studies describing the use of this formulation exist in patients under the age of 18 years. This study describes our experience using IV posaconazole in paediatric and young adult cancer patients.
This single-centre retrospective chart review evaluated patients who received IV posaconazole and had at least one posaconazole plasma concentration obtained after five or more days with a consistent dosage. Relationships between doses required to achieve a plasma concentration of ≥1 µg/mL and patient age, weight and body surface area (BSA) were evaluated. The clinical record was reviewed to identify descriptions of any adverse events.
Twenty-five patients were analysed, with a median age of 10.5 years (range 1.9-22.9 years; 92% were <18 years). All patients were able to achieve a posaconazole plasma concentration ≥1 µg/mL during their treatment course. The daily mg/kg/day dose required to achieve the target concentration decreased significantly with increasing age of the patient (P = 0.018). Assessment of dosage based on BSA suggested a requirement of 225 mg/m2/day across all age groups <18 years. Adverse events documented in the clinical record were consistent with those described with the oral formulations. No CNS toxicities were observed with use of IV posaconazole.
Concentrations ≥1 µg/mL are achievable and a BSA-based dosing approach may allow a consistent empirical dose for patients <18 years of age. Therapeutic drug monitoring is recommended to ensure patients achieve therapeutic concentrations.
泊沙康唑具有广谱抗真菌活性。2014 年推出了一种静脉注射制剂。在 18 岁以下的患者中，关于该制剂使用的研究较少。本研究描述了我们在儿科和年轻成年癌症患者中使用静脉注射泊沙康唑的经验。
这项单中心回顾性图表研究评估了接受静脉注射泊沙康唑且至少有一次在 5 天以上且剂量一致时获得的泊沙康唑血浆浓度的患者。评估了达到 ≥1μg/ml 血浆浓度所需的剂量与患者年龄、体重和体表面积（BSA）之间的关系。回顾临床记录以确定任何不良事件的描述。
分析了 25 例患者，中位年龄为 10.5 岁（范围 1.9-22.9 岁；92%<18 岁）。所有患者在治疗过程中均能达到泊沙康唑血浆浓度≥1μg/ml。达到目标浓度所需的每日 mg/kg/天剂量与患者年龄呈显著负相关（P=0.018）。基于 BSA 的剂量评估表明，所有<18 岁的年龄组均需要 225mg/m2/天的剂量。临床记录中记录的不良事件与口服制剂描述的一致。静脉注射泊沙康唑未观察到 CNS 毒性。
可达到浓度≥1μg/ml，基于 BSA 的给药方法可使<18 岁的患者获得一致的经验性剂量。建议进行治疗药物监测，以确保患者达到治疗浓度。
