Posaconazole is a broad-spectrum
triazole widely used to prevent and treat
invasive mycoses in adults. Since it received marketing authorization more than a decade ago, many authors have reported on its
off-label use in pediatric patients, despite the fact that the pharmacokinetics, safety, and efficacy in children have not been extensively investigated. Areas covered: We reviewed pediatric studies published between 2010 and 2017 describing the prophylactic and
therapeutic use of
posaconazole, with special attention to the correlation between oral dose, plasma levels, safety, and effectiveness. We found that
posaconazole is well tolerated in children with a low incidence of adverse effects. As in adults,
posaconazole absorption is hampered by factors such as high gastric pH,
mucositis, and concomitant medications, whereas there is no direct correlation between the daily dose and the trough plasma concentration due to saturable absorption. Expert Commentary:
Posaconazole has proved safe and effective in preventing and treating
fungal infections in immunocompromised children. A
body-weight-based dosing regimen and therapeutic
drug monitoring are recommended to optimize
posaconazole plasma concentration. Absorption can be improved by high-fat foods or avoiding the use of
proton-pump inhibitors. Further pediatric studies are needed especially for the new formulations of
posaconazole (vials and
tablets).