The need for area under the curve measurements in the field of ganciclovir therapeutic drug monitoring in children : a case report

© 2021. The Author(s)..

BACKGROUND: Ganciclovir pharmacokinetics is characterized by a high variability in drug exposure. Usually, monitoring of ganciclovir exposure is performed by measuring trough concentration. However, due to the specificity of pediatric pharmacokinetics, trough concentration measurements may not be a relevant surrogate of ganciclovir exposure. Area under the curve of concentration (AUC) may be a more appropriate biomarker.

CASE PRESENTATION: We report the case of 3.6-year-old boy with Emberger syndrome with a cytomegalovirus reactivation occurring after allogenic hematopoietic stem cell transplantation. After a few days of treatment with intravenous ganciclovir, sub-therapeutic trough ganciclovir concentrations were measured (< 0.5 µg/mL) and viral load still increased. Ganciclovir dosage was increased by two-fold to deal with this treatment failure. Trough concentrations remained sub-therapeutic. The patient had hematologic disorder therefore it was decided to estimate ganciclovir AUC to assess more accurately drug exposure before any further dosage modification. AUC0-12 h was measured at 51 μg h/mL, which was within the therapeutic range (40-60 μg h/mL). Afterward, viral load decreased and became undetectable.

CONCLUSIONS: This case report highlights that monitoring ganciclovir exposure based on AUC should be performed to tailor drug dosage in order to improve treatment efficacy and safety in pediatric patients.

Medienart:

E-Artikel

Erscheinungsjahr:

2021

Erschienen:

2021

Enthalten in:

Zur Gesamtaufnahme - volume:21

Enthalten in:

BMC infectious diseases - 21(2021), 1 vom: 08. Nov., Seite 1143

Sprache:

Englisch

Beteiligte Personen:

Duval, Xavier [VerfasserIn]
Lemaitre, Florian [VerfasserIn]
Pertuisel, Sophie [VerfasserIn]
Probert, Jamie [VerfasserIn]
Gandemer, Virginie [VerfasserIn]
Verdier, Marie-Clémence [VerfasserIn]
Tron, Camille [VerfasserIn]

Links:

Volltext

Themen:

Antiviral Agents
Antiviral therapy
Case Reports
Cytomegalovirus (CMV)
Ganciclovir
Hematopoietic stem cell transplantation
Journal Article
P9G3CKZ4P5
Pediatrics
Pharmacokinetics
Therapeutic drug monitoring

Anmerkungen:

Date Completed 10.11.2021

Date Revised 12.11.2021

published: Electronic

Citation Status MEDLINE

doi:

10.1186/s12879-021-06828-8

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

NLM332876942