Clinical application of voriconazole in pediatric patients: a systematic review

Hu, Lin; Huang, Juanjuan; Li, Yanfei; He, Gefei

doi:10.1186/s13052-024-01684-z

Ital J Pediatr

2024

DOI: 10.1186/s13052-024-01684-z

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Clinical application of voriconazole in pediatric patients: a systematic review

Lin Hu,

Juanjuan Huang,

Yanfei Li

et al.

Abstract: The purpose of this study was to review the literature on the clinical use of voriconazole (VRC) in pediatric patients. MEDLINE, Embase, PubMed, Web of Science, and Cochrane Library were searched from January 1, 2000, to August 15, 2023 for relevant clinical studies on VRC use in pediatric patients. Data were collected based on inclusion and exclusion criteria, and a systematic review was performed on recent research related to the use of VRC in pediatric patients. This systematic review included a total of 35… Show more

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2024

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Cited by 2 publications

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Therapeutic drug monitoring and safety of voriconazole in patients with liver dysfunction

Hu,

Su,

Tang

et al. 2024

Antimicrob Agents Chemother

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This study aims to describe the distribution characteristics of voriconazole (VRC) plasma trough concentrations ( C trough ) in patients with liver dysfunction, identify factors influencing VRC C trough , and provide recommendations for the use of VRC in this population. We retrospectively collected medical records of hospitalized patients with liver dysfunction who used VRC and underwent therapeutic drug monitoring (TDM) at the First Hospital of Changsha. The severity of liver dysfunction was assessed by the Child–Pugh (CP) score. Multiple linear regression was employed to explore factors affecting VRC C trough in these patients. A total of 147 C trough from 102 patients with liver dysfunction were analyzed. Patients were categorized into a control group ( n = 40), CP-A ( n = 39), CP-B ( n = 11), and CP-C group ( n = 12). The initial probability of target attainment of C trough was 70.6%, with 6.9% of patients obtaining subtherapeutic C trough and 22.5% obtaining supertherapeutic C trough . The initial C trough in CP-A and B were 5.05 (0.64–9.57) mg/L and 5.37 (0.26–10.01) mg/L, respectively, significantly higher than the control group ( P = 0.021 and P = 0.010). The proportion of VRC C trough of >5.5 mg/L in CP-A and B was 33.3% and 45.5%, respectively. Multiple linear regression analysis revealed that factors such as age ≥70 years, CP class, C-reactive protein (CRP), and direct bilirubin were significantly related to the initial VRC C trough . Among all measurements, patients with severe inflammation (CRP >100 mg/L), aged ≥70 years, and albumin levels of <30 or <25 g/L had significantly higher VRC C trough . The treatment success rate of VRC was 69.6% (71 of 102), and the rate of VRC-related adverse drug reactions was 29.4% (30 of 102). The recommended half-maintenance dose may lead to elevated VRC C trough in patients with CP-A and CP-B. TDM is essential for patients with advanced age, severe infections, or hypoalbuminemia to prevent excessive VRC trough levels.

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Therapeutic drug monitoring and safety of voriconazole in patients with liver dysfunction

Hu,

Su,

Tang

et al. 2024

Antimicrob Agents Chemother

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Associated factors with voriconazole plasma concentration: a systematic review and meta-analysis

Li,

Hu,

2024

Front. Pharmacol.

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Background: Voriconazole plasma concentration exhibits significant variability and maintaining it within the therapeutic range is the key to enhancing its efficacy. We conducted a systematic review and meta-analysis to estimate the prevalence of patients achieving the therapeutic range of plasma voriconazole concentration and identify associated factors.Methods: Eligible studies were identified through the PubMed, Embase, Cochrane Library, and Web of Science databases from their inception until 18 November 2023. We conducted a meta-analysis using a random-effects model to determine the prevalence of patients who reached the therapeutic plasma voriconazole concentration range. Factors associated with plasma voriconazole concentration were summarized from the included studies.Results: Of the 60 eligible studies, 52 reported the prevalence of patients reaching the therapeutic range, while 20 performed multiple linear regression analyses. The pooled prevalence who achieved the therapeutic range was 56% (95% CI: 50%–63%) in studies without dose adjustment patients. The pooled prevalence of adult patients was 61% (95% CI: 56%–65%), and the pooled prevalence of children patients was 55% (95% CI: 50%–60%) The study identified, in the children population, several factors associated with plasma voriconazole concentration, including age (coefficient 0.08, 95% CI: 0.01 to 0.14), albumin (−0.05 95% CI: −0.09 to −0.01), in the adult population, some factors related to voriconazole plasma concentration, including omeprazole (1.37, 95% CI 0.82 to 1.92), pantoprazole (1.11, 95% CI: 0.17–2.04), methylprednisolone (−1.75, 95% CI: −2.21 to −1.30), and dexamethasone (−1.45, 95% CI: −2.07 to −0.83).Conclusion: The analysis revealed that only approximately half of the patients reached the plasma voriconazole concentration therapeutic range without dose adjustments and the pooled prevalence of adult patients reaching the therapeutic range is higher than that of children. Therapeutic drug monitoring is crucial in the administration of voriconazole, especially in the children population. Particular attention may be paid to age, albumin levels in children, and the use of omeprazole, pantoprazole, dexamethasone and methylprednisolone in adults.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023483728.

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Clinical application of voriconazole in pediatric patients: a systematic review

Cited by 2 publications

References 56 publications

Therapeutic drug monitoring and safety of voriconazole in patients with liver dysfunction

Therapeutic drug monitoring and safety of voriconazole in patients with liver dysfunction

Associated factors with voriconazole plasma concentration: a systematic review and meta-analysis

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