Optimized Administration of Voriconazole and Therapeutic Drug Monitoring in Children and Adolescents: A Single-Centre Retrospective Experience from China

Abstract Background Voriconazole (VRC) is a triazole anti-fungal agent and a first-line treatment for invasive fungal infection (IFI) generally. The purpose of our study was performed to explore the factors affecting voriconazole trough concentration (Ctrough) and to show VRC dose adjustment experience in children. Methods The demographic information, concentration data, CYP2C19 genotypes and clinical outcomes of eligible children from January 1th, 2016 to December 31th, 2018 were collected. Factors affecting the voriconazole trough concentration were statistically analyzed. Results A total of 145 trough concentrations in 94 patients were included in this study, 54.5% of which achieved the target concentrations; however, 35.9% and 9.6% of which were sub-therapeutic and super-therapeutic post-multiple dosing. For children ≤ 2, 2–6, 6–12, and 12–18 years, the median VRC maintenance doses of 5.7, 6.7, 5.0 and 3.3 mg/kg twice daily respectively had been required in order to achieve therapeutic level (P < 0.001). Co-administration of proton pump inhibitors affected VRC target trough concentration significantly (P = 0.001). Conclusion Younger pediatric patients might need a higher dosage regime to achieve therapeutic trough concentration. In order to ensure the effectiveness and safety of voriconazole in children, early and repeat monitoring of voriconazole is a powerful tool.