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Intravenous Voriconazole Therapy in a Preterm Infant
Author(s) -
Muldrew Kendre'a M.,
Maples Holly D.,
Stowe Cindy D.,
Jacobs Richard F.
Publication year - 2005
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1592/phco.2005.25.6.893
Subject(s) - voriconazole , medicine , concomitant , fluconazole , regimen , pharmacokinetics , phenobarbital , amphotericin b , anesthesia , volume of distribution , pharmacology , antifungal , dermatology
A preterm infant younger than 3 months developed a disseminated fluconazole‐resistant Candida albicans infection that was treated with liposomal amphotericin B for 52 days, followed by the combination of intravenous voriconazole and liposomal amphotericin B for an additional 19 days. The infant received concomitant phenobarbital throughout the hospital stay. The infection resolved after addition of voriconazole to the treatment regimen. Intravenous voriconazole was begun at a high dosage, 6 mg/kg every 12 hours, for anticipated developmental and drug‐induced changes in volume of distribution and clearance. On day 4 of therapy, serum concentrations of voriconazole were 3.27 μg/ml immediately after infusion and 0.33 μg/ml 6 hours after infusion. These levels were significantly lower than those achieved in adult pharmacokinetic and safety studies. After the infant's dosage was increased to 6 mg/kg every 8 hours, serum concentrations were 5.33 μg/ml 30 minutes after infusion and 2.67 μg/ml 6 hours after infusion. These levels were similar to those observed in adults. Intravenous voriconazole 6 mg/kg every 8 hours was administered safely, with concomitant phenobarbital therapy, in this preterm infant with developmentally diminished renal function.