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Pediatr Hematol Oncol. 2015;32(8):557-67. doi: 10.3109/08880018.2015.1088905. Epub 2015 Nov 11.

The Clinical Significance of Voriconazole Therapeutic Drug Monitoring in Children With Invasive Fungal Infections.

Kang HM1,2, Lee HJ1,2, Cho EY2,3, Yu KS4, Lee H2,5, Lee JW1,6, Kang HJ1,6, Park KD1,6, Shin HY1,6, Choi EH1,2.

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a Department of Pediatrics , Seoul National University Hospital , Seoul , South Korea.
b Department of Pediatrics , Seoul National University College of Medicine , Seoul , South Korea.
c Department of Pediatrics , Chungnam National University Hospital , Daejeon , South Korea.
d Department of Clinical Pharmacology and Therapeutics , Seoul National University College of Medicine , Seoul , South Korea.
e Department of Pediatrics , Seoul National University Bundang Hospital , Seongnam , South Korea.
f Department of Pediatrics , Cancer Research Institute, Seoul National University College of Medicine , Seoul , South Korea.


Voriconazole is an antifungal drug used to treat fungal infections. This was a retrospective study of 61 children with hemato-oncologic diseases or solid organ transplantation who were administered voriconazole for invasive fungal infections. Of the 61 patients, 31 (50.8%) were in the therapeutic drug monitoring (TDM) group, and 30 (49.2%) were in the non-TDM group. At 12 weeks, treatment failure rate in the non-TDM group was higher than the TDM group (78.6% versus 40.0%, p = 0.038). Drug discontinuation due to adverse events was less frequent in the TDM group than the non-TDM group (26.0% versus 92.3%, p = 0.001). Children required higher dosages to maintain drug levels within the targeted therapeutic range: an average of 8.3 mg/kg/dose in patients <12 years old and 6.9 mg/kg/dose for those ≥12 years old. Treatment failure rates were higher in patients whose voriconazole levels remained below 1.0 mg/L for more than 50% of their treatment duration than those above 1.0 mg/L (71.4% vs. 9.1% after 12 weeks, p = 0.013). Serial monitoring of voriconazole levels in children is important for improving treatment response and preventing unnecessary drug discontinuation. Higher dosages are needed in children to reach therapeutic range.


adverse events; children; therapeutic drug monitoring; treatment response; voriconazole

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