Masetti Riccardo, Bossù Gianluca, Muratore Edoardo, Leardini Davide, Gatti Milo, Di Sario Riccardo, Pea Federico, Esposito Susanna
Pediatric Hematology and Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy.
Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.
Paediatr Drugs. 2025 Jan;27(1):41-56. doi: 10.1007/s40272-024-00663-5. Epub 2024 Nov 6.
The risk of fungal, bacterial, and viral infections is higher in children with hematological and solid malignancies, particularly during periods of profound neutropenia. Although early administration of antimicrobial agents is common, optimizing pharmacological therapy in pediatric patients with cancer is challenging because of their variable pharmacokinetics compared with adults, including differences in body mass and augmented renal clearance, as well as chemotherapy-induced organ toxicity. Therapeutic drug monitoring, which involves measuring drug concentrations in serum or plasma at specific timepoints and adjusting doses accordingly, can be applied to various medications. While standardized targets for all antimicrobial agents in children are lacking, therapeutic drug monitoring appears to be beneficial in preventing serious toxicity and addressing treatment failure or non-compliance. This narrative review aims to analyze current perspectives on therapeutic drug monitoring for antimicrobial drugs in the special population of children with hematological or oncological diseases, including those undergoing hematopoietic cell transplantation. The review provides evidence on the clinical benefits of this method and explores potential future developments in this area.
血液系统和实体恶性肿瘤患儿发生真菌、细菌和病毒感染的风险较高，尤其是在严重中性粒细胞减少期间。尽管早期使用抗菌药物很常见，但由于与成人相比，儿科癌症患者的药代动力学存在差异，包括体重差异和肾脏清除率增加，以及化疗引起的器官毒性，因此优化其药物治疗具有挑战性。治疗药物监测涉及在特定时间点测量血清或血浆中的药物浓度并相应调整剂量，可应用于各种药物。虽然缺乏针对儿童所有抗菌药物的标准化目标，但治疗药物监测似乎有助于预防严重毒性并解决治疗失败或不依从问题。本叙述性综述旨在分析血液学或肿瘤性疾病特殊儿童群体（包括接受造血细胞移植的儿童）对抗菌药物进行治疗药物监测的当前观点。该综述提供了关于该方法临床益处的证据，并探讨了该领域未来的潜在发展。
