Available online 27 August 2022, 106289

What is already known about this subject:

Posaconazole as a primary antifungal prophylaxis has been verified safe and effective in children during chemotherapy.

A high-fat diet improved the bioavailability of posaconazole in adults. However, the effect of a high-fat diet on the pharmacokinetics of posaconazole in children has not yet been studied using the population pharmacokinetic approach.

What this study adds:

The bioavailability of posaconazole suspension increased 1.95-fold with a high-fat diet compared to a regular diet in paediatric patients.

Four times daily dosing was necessary to achieve the adequate exposure. The dose regimens of 4 mg/kg qid and 6 mg/kg qid were recommended for prophylaxis and treatment, respectively.

This study aimed to investigate the effect of food on the pharmacokinetics of posaconazole suspension in pediatric patients with acute leukaemia and to recommend optimal dosing strategies. This single-site, prospective, open-label, observational study was conducted in 42 patients and included 186 plasma concentrations of posaconazole. Sparse data were analyzed using population pharmacokinetic modeling. Monte Carlo simulations were conducted to predict the morning trough concentrations at steady-state with the proposed dose of 2-7 mg/kg three times daily (tid) or four times daily (qid) for bodyweights of 10-36 kg. The target concentrations were 700 ng/mL for prophylaxis and 1000 ng/mL for treatment. Dosage regimens with percentage of target attainment (PTA) ≥70% were recommended. A one-compartment model with allometric scaling adequately described the pharmacokinetic profile. The apparent clearance was 9.05 L/h (95% confidence interval [CI] 7.14–11.09) and the apparent volume of distribution was 283 L (95% CI 168–491) for a typical individual of 17.5 kg. The relative bioavailability with high-fat diet was as high as 1.95-fold compared with regular food. Following the intake of regular meals, 4 mg/kg qid was adequate with a PTA ≥ 71.8% for prophylaxis. A dosage of 6 mg/kg qid under a regular diet reached a PTA ≥ 73.4% for treatment. The recommended dosage of posaconazole for prophylaxis and treatment could be predicted by the pharmacokinetic model based on bodyweight and diet type in pediatric patients.

posaconazole

population pharmacokinetics

pediatrics

food effect

antifungal prophylaxis and therapy

© 2022 The Author(s). Published by Elsevier B.V.