Weerdenburg Heather, Gwee Amanda, Haeusler Gabrielle M, Osowicki Joshua, Boast Alison
Department of Pharmacy, Children's Cancer Centre, and General Medicine, The Royal Children's Hospital, Melbourne, Australia.
Antimicrobials, Clinical Paediatrics and Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, Australia.
J Antimicrob Chemother. 2024 Dec 2;79(12):3340-3343. doi: 10.1093/jac/dkae373.
Therapeutic drug monitoring (TDM) is recommended for posaconazole to achieve target concentrations of ≥0.7 mg/L and ≥1.0 mg/L for prophylaxis and treatment of invasive fungal infection (IFI), respectively. However, target attainment is challenging with the oral suspension, particularly in children. Here, we describe our experience using crushed delayed-release tablet (DRT) in a paediatric cohort, with a focus on TDM.
We undertook a retrospective audit of crushed posaconazole DRT administration via enteral feeding tubes (EFTs) for patients aged ≤18 years over 18 months at The Royal Children's Hospital Melbourne who had at least one trough concentration measured at steady state. Details of patient demographics, posaconazole dosing, monitoring and adverse effects were recorded.
Twelve patients with a median age of 9 years (range 2 to 14) received posaconazole DRT via EFT for prophylaxis (n = 8) or treatment (n = 4). All children achieved target concentration, with a median dose of 7 mg/kg/day (range 5 to 11) for prophylaxis and 13 mg/kg/day (range 9 to 20) for treatment. The median time to reach therapeutic levels was 7 days (range 5 to 14) for prophylaxis and 20 days (range 15 to 35) for treatment. One child had blockage of their EFT, which was attributed to posaconazole. No other adverse effects were observed.
Crushed posaconazole DRT administered via EFT may be used as a method of attaining therapeutic posaconazole concentrations in children for antifungal prophylaxis and treatment.
泊沙康唑推荐进行治疗药物监测（TDM），以分别达到≥0.7mg/L和≥1.0mg/L的目标浓度用于侵袭性真菌感染（IFI）的预防和治疗。然而，口服混悬液达到目标浓度具有挑战性，尤其是在儿童中。在此，我们描述了在儿科队列中使用碾碎的缓释片（DRT）的经验，重点是TDM。
我们对墨尔本皇家儿童医院18个月内通过肠内喂养管（EFT）给予年龄≤18岁患者碾碎的泊沙康唑DRT进行了回顾性审计，这些患者在稳态时至少测量了一次谷浓度。记录了患者人口统计学、泊沙康唑给药、监测和不良反应的详细信息。
12名中位年龄为9岁（范围2至14岁）的患者通过EFT接受泊沙康唑DRT用于预防（n = 8）或治疗（n = 4）。所有儿童均达到目标浓度，预防的中位剂量为7mg/kg/天（范围5至11），治疗的中位剂量为13mg/kg/天（范围9至20）。达到治疗水平的中位时间预防为7天（范围5至14），治疗为20天（范围15至35）。一名儿童的EFT堵塞，这归因于泊沙康唑。未观察到其他不良反应。
通过EFT给予碾碎的泊沙康唑DRT可作为在儿童中达到治疗性泊沙康唑浓度以进行抗真菌预防和治疗的一种方法。
