Physiologically‐Based Pharmacokinetic Modeling of Fluconazole Using Plasma and Cerebrospinal Fluid Samples From Preterm and Term Infants. (22nd May 2019)

• Record Type: Journal Article
• Authors: Gerhart, Jacqueline G.; Watt, Kevin M.; Edginton, Andrea; Wade, Kelly C.; Salerno, Sara N.; Benjamin, Daniel K.; Smith, P. Brian; Hornik, Christoph P.; Cohen‐Wolkowiez, Michael; Duara, Shahnaz; Ross, Ashley; Shattuck, Karen; Stewart, Dan L.; Neu, Natalie; Gonzalez, Daniel
• Other Names: Furda Gary investigator.; Benjamin Danny investigator.; Capparelli Edmund investigator.; Kearns Gregory L. investigator.; Paul Ian M. investigator.; Sullivan Jan investigator.; Wade Kelly investigator.
• Is Part Of: CPT: pharmacometrics & systems pharmacology. Volume 8:Number 7(2019)
• Page Start: 500
• Page End: 510
• Publication Date: 2019-05-22
• Subjects: Pharmacokinetics -- Periodicals; Pharmacology -- Periodicals; Pharmacokinetics; Periodicals; 615.05
• DOI: 10.1002/psp4.12414
• Languages: English
• ISSNs: 2163-8306

Abstract

Abstract : Fluconazole is used to treat hematogenous Candida meningoencephalitis in preterm and term infants. To characterize plasma and central nervous system exposure, an adult fluconazole physiologically‐based pharmacokinetic (PBPK) model was scaled to infants, accounting for age dependencies in glomerular filtration and metabolism. The model was optimized using 760 plasma samples from 166 infants (median postmenstrual age (range) 28 weeks (24–50)) and 27 cerebrospinal fluid (CSF) samples from 22 infants (postmenstrual age 28 weeks (24–33)). Simulations evaluated achievement of the surrogate efficacy target of area under the unbound concentration‐time curve ≥ 400 mg hour/L over the dosing interval in plasma and CSF using dosing guidelines. Average fold error of predicted concentrations was 0.73 and 1.14 for plasma and CSF, respectively. Target attainment in plasma and CSF was reached faster after incorporating a loading dose of 25 mg/kg. PBPK modeling can be useful in exploring CNS kinetics of drugs in children.