Clinical pharmacokinetics and pharmacodynamics of ganciclovir and valganciclovir in children with cytomegalovirus infection

Abstract

Introduction: Among infants and immunocompromised children cytomegalovirus (CMV) is associated with significant morbidity and mortality.

Areas covered: This review describes the clinical pharmacokinetics and pharmacodynamics of ganciclovir and valganciclovir for the treatment and prevention of CMV infection in children.

Expert opinion: A 24-h ganciclovir area under the concentration versus time curve (AUC_{0 – 24}) of 40 – 60 μg h/ml decreased the risk of CMV infection for adults undergoing CMV prophylaxis. For adults undergoing treatment for active CMV disease, a target AUC_{0 – 12} of 40 – 60 μg h/ml has been suggested. The applicability of these targets to children remains uncertain; however, with the most sophisticated dosing regimens developed to date only 21% of patients are predicted to reach these targets. Moving forward, identification of optimal pediatric ganciclovir and valganciclovir dosing regimens may involve the use of an externally validated pediatric population pharmacokinetic model for empirical dosing, an optimal sampling strategy for collecting a minimal number of blood samples for each patient and Bayesian updating of the dosing regimen based on an individual patient’s pharmacokinetic profile.

Keywords:

• antiviral
• cytomegalovirus
• pediatric
• population pharmacokinetics

Declaration of interest

C Stockmann is supported by the American Foundation for Pharmaceutical Education’s Clinical Pharmaceutical Sciences Fellowship. JK Roberts is supported by the Pharmacotherapy Subspecialty Award from the Primary Children’s Hospital Foundation. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

Notes

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