{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T04:30:11Z","timestamp":1786509011689,"version":"build-2736575974"},"reference-count":34,"publisher":"Ovid Technologies (Wolters Kluwer Health)","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\n Background:<\/jats:title>\n Posaconazole suspension is widely used for the prophylaxis of breakthrough invasive fungal infections in high-risk children. Due to its low bioavailability and high pharmacokinetic variability, therapeutic drug monitoring (TDM) is recommended.<\/jats:p>\n <\/jats:sec>\n \n Objectives:<\/jats:title>\n To describe prophylactic posaconazole suspension TDM in children, evaluate its effectiveness and investigate factors influencing its pharmacokinetics.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n \n Retrospective observational study from 2017\u20132023, including consecutive patients <18 years receiving prophylaxis with posaconazole suspension for \u22651 week and with \u22651 posaconazole serum concentration (trough concentration [C\n trough<\/jats:sub>\n ]).\n <\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n Seventy-one patients were included (median age 4.8 [interquartile range, IQR 2.4\u20138.9] years). The most frequent underlying condition was inborn errors of immunity (23, 32.4%); 55 patients (77.5%) had undergone hematopoietic stem-cell transplantation. Out of 373 C\n trough<\/jats:sub>\n , 178 (47.7%) were within the therapeutic range and 187 (50.1%) were subtherapeutic. The median posaconazole dose was significantly higher in patients under 2 (17.4 [IQR 12.6\u201323.7] mg\/kg\/day vs. 13.4 [IQR 12.0\u201318.4] mg\/kg\/day,\n P<\/jats:italic>\n < 0.001). Nausea\/vomiting (odds ratio [OR] 4.89; 95% confidence interval 2.09\u201311.44;\n P<\/jats:italic>\n = 0.0003) and concomitant proton pump inhibitor use (OR 3.03; 95% confidence interval 1.15\u20137.95;\n P<\/jats:italic>\n = 0.0248) were significantly associated with subtherapeutic C\n trough<\/jats:sub>\n . Proven breakthrough invasive fungal infections occurred in 3 (4.2%) patients, with no statistically significant difference in subtherapeutic C\n trough<\/jats:sub>\n values compared with the rest of the cohort (\n P<\/jats:italic>\n = 0.128). Toxicity was not related to supratherapeutic C\n trough<\/jats:sub>\n .\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n \n Our study highlights the importance of TDM in pediatric patients receiving posaconazole suspension, particularly those with risk factors associated with subtherapeutic C\n trough<\/jats:sub>\n . Although further studies are needed to define the optimal dosage in children under 2, our findings suggest that these patients should receive at least 15\u2009mg\/kg\/day.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1097\/inf.0000000000005347","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T04:00:29Z","timestamp":1786507229000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Optimizing Posaconazole Suspension Prophylaxis in Pediatric Patients: The Key Role of Therapeutic Drug Monitoring"],"prefix":"10.1097","author":[{"given":"Maria","family":"\u00c1lvarez de Toledo","sequence":"first","affiliation":[{"name":"Paediatric Infectious Diseases and Immunodeficiencies Unit, Children\u2019s Hospital, Vall d\u2019Hebron Barcelona Hospital Campus, Barcelona, Catalonia, Spain"},{"name":"Vall d\u2019Hebron Research Institute, Barcelona, Catalonia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Blanca","family":"Guembe Zabaleta","sequence":"additional","affiliation":[{"name":"Pharmacy Department, Vall d\u2019Hebron Barcelona Hospital Campus, Barcelona, Catalonia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Barenblit-Mas","sequence":"additional","affiliation":[{"name":"Paediatric Infectious Diseases and Immunodeficiencies Unit, Children\u2019s Hospital, Vall d\u2019Hebron Barcelona Hospital Campus, Barcelona, Catalonia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda","family":"Larrosa-Garc\u00eda","sequence":"additional","affiliation":[{"name":"Vall d\u2019Hebron Research Institute, Barcelona, Catalonia, Spain"},{"name":"Pharmacy Department, Vall d\u2019Hebron Barcelona Hospital Campus, Barcelona, Catalonia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4545-8560","authenticated-orcid":false,"given":"Aurora","family":"Fernandez-Polo","sequence":"additional","affiliation":[{"name":"Vall d\u2019Hebron Research Institute, Barcelona, Catalonia, Spain"},{"name":"Pharmacy Department, Vall d\u2019Hebron Barcelona Hospital Campus, Barcelona, Catalonia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Castellote","sequence":"additional","affiliation":[{"name":"Department of Clinical Biochemistry, Vall d\u2019Hebron Barcelona Hospital Campus, Barcelona, Catalonia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1999-4530","authenticated-orcid":false,"given":"Laura","family":"Roig-Soria","sequence":"additional","affiliation":[{"name":"Paediatric Infectious Diseases and Immunodeficiencies Unit, Children\u2019s Hospital, Vall d\u2019Hebron Barcelona Hospital Campus, Barcelona, Catalonia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4502-1265","authenticated-orcid":false,"given":"Berta","family":"Renedo Mir\u00f3","sequence":"additional","affiliation":[{"name":"Pharmacy Department, Vall d\u2019Hebron Barcelona Hospital Campus, Barcelona, Catalonia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Teresa","family":"Mart\u00edn G\u00f3mez","sequence":"additional","affiliation":[{"name":"Vall d\u2019Hebron Research Institute, Barcelona, Catalonia, Spain"},{"name":"Microbiology Department, Vall d\u2019Hebron Barcelona Hospital Campus, Barcelona, Catalonia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Alonso Garc\u00eda","sequence":"additional","affiliation":[{"name":"Vall d\u2019Hebron Research Institute, Barcelona, Catalonia, Spain"},{"name":"Paediatric Haematology and Oncology Department, Stem Cell Transplant Unit, Children\u2019s Hospital, Vall d\u2019Hebron Barcelona Hospital Campus, Barcelona, Catalonia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonia","family":"Garcia-Garcia","sequence":"additional","affiliation":[{"name":"Vall d\u2019Hebron Research Institute, Barcelona, Catalonia, Spain"},{"name":"Pharmacy Department, Vall d\u2019Hebron Barcelona Hospital Campus, Barcelona, Catalonia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2035-8291","authenticated-orcid":false,"given":"Natalia","family":"Mendoza-Palomar","sequence":"additional","affiliation":[{"name":"Paediatric Infectious Diseases and Immunodeficiencies Unit, Children\u2019s Hospital, Vall d\u2019Hebron Barcelona Hospital Campus, Barcelona, Catalonia, Spain"},{"name":"Vall d\u2019Hebron Research Institute, Barcelona, Catalonia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0346-5570","authenticated-orcid":false,"given":"Pere","family":"Soler-Palacin","sequence":"additional","affiliation":[{"name":"Paediatric Infectious Diseases and Immunodeficiencies Unit, Children\u2019s Hospital, Vall d\u2019Hebron Barcelona Hospital Campus, Barcelona, Catalonia, Spain"},{"name":"Vall d\u2019Hebron Research Institute, Barcelona, Catalonia, Spain"},{"name":"Universitat Aut\u00f3noma de Barcelona, Barcelona, Catalonia, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,8,12]]},"reference":[{"key":"R1-20260812","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.riam.2021.04.005","article-title":"La infecci\u00f3n f\u00fangica en el paciente pedi\u00e1trico inmunodeprimido.","volume":"38","author":"Gonz\u00e1lez-Vicent","year":"2021","journal-title":"Rev Iberoam 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