Optimisation of voriconazole treatment in paediatric patients with Aspergillus flavus fungal endocarditis: a pharmacokinetics case report

The case study presented involves a paediatric patient treated with voriconazole for fungal endocarditis caused by Aspergillus flavus Therapeutic plasma concentrations of voriconazole could not be achieved with the established dosing regimen and administration frequency. In response to this situation, and after successive dose increases and a pharmacogenetic analysis that confirmed the patient was not a CYP2C19 or CYP2C9 rapid or ultra-rapid metaboliser, a new administration frequency of every 8 hours was proposed, with limited evidence, but which allowed achieving target concentrations and patient improvement. This study highlights the importance of voriconazole monitoring, especially in paediatric patients, given the wide variety of factors that can alter its plasma concentrations. The study also calls for future studies to evaluate the utility of an 8 hourly dosing regimen, providing the possibility of avoiding switching voriconazole to another antifungal with less evidence in the paediatric population, a relevant issue in terms of resistance.