Need of voriconazole high dosages, with documented cerebrospinal fluid penetration, for treatment of cerebral aspergillosis in a 6-month-old leukaemic girl

This case report indicates the usefulness of voriconazole for the treatment of central nervous system (CNS) aspergillosis, also in paediatrics. However, it also confirms the need for therapeutic drug monitoring (TDM), especially in younger children that may require very high dosages in order to achieve plasma and cerebrospinal fluid (CSF) therapeutic concentrations.

[1]  E. Roilides,et al.  Fourth European Conference on Infections in Leukaemia (ECIL-4): guidelines for diagnosis, prevention, and treatment of invasive fungal diseases in paediatric patients with cancer or allogeneic haemopoietic stem-cell transplantation. , 2014, The Lancet. Oncology.

[2]  P. Troke,et al.  Tissue Penetration of Antifungal Agents , 2014, Clinical Microbiology Reviews.

[3]  T. Patterson,et al.  A Reference Laboratory Experience of Clinically Achievable Voriconazole, Posaconazole, and Itraconazole Concentrations within the Bloodstream and Cerebral Spinal Fluid , 2013, Antimicrobial Agents and Chemotherapy.

[4]  C. Viscoli,et al.  Current research in empirical therapy for febrile neutropenia in cancer patients: what should be necessary and what is going on , 2013, Expert opinion on emerging drugs.

[5]  G. Würthwein,et al.  Monitoring of voriconazole plasma concentrations in immunocompromised paediatric patients. , 2012, The Journal of antimicrobial chemotherapy.

[6]  T. Egberts,et al.  Highly Variable Plasma Concentrations of Voriconazole in Pediatric Hematopoietic Stem Cell Transplantation Patients , 2012, Antimicrobial Agents and Chemotherapy.

[7]  D. Benjamin,et al.  Therapeutic Monitoring of Voriconazole in Children Less Than Three Years of Age: A Case Report and Summary of Voriconazole Concentrations for Ten Children , 2012, The Pediatric infectious disease journal.

[8]  P. Soler-Palacín,et al.  Voriconazole drug monitoring in the management of invasive fungal infection in immunocompromised children: a prospective study. , 2012, The Journal of antimicrobial chemotherapy.

[9]  G. Meyfroidt,et al.  Voriconazole plasma levels in children are highly variable , 2011, European Journal of Clinical Microbiology & Infectious Diseases.

[10]  H. Shimada,et al.  Differences in voriconazole trough plasma concentrations per oral dosages between children younger and older than 3 years of age , 2010, Pediatric blood & cancer.

[11]  J. Kosterink,et al.  Clinical relevance of the pharmacokinetic interactions of azole antifungal drugs with other coadministered agents. , 2009, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[12]  D. Denning,et al.  Voriconazole plasma monitoring , 2008, Archives of Disease in Childhood.

[13]  Thierry Buclin,et al.  Voriconazole therapeutic drug monitoring in patients with invasive mycoses improves efficacy and safety outcomes. , 2008, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[14]  J. Burhenne,et al.  Successful treatment with voriconazole of Aspergillus brain abscess in a boy with medulloblastoma , 2007, Pediatric blood & cancer.

[15]  Richard Sylvester,et al.  Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. , 2002, The New England journal of medicine.

[16]  R. Jelliffe,et al.  Voriconazole pharmacokinetics and pharmacodynamics in children. , 2010, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.