What is known and objective: Ganciclovir is a first-line antiviral agent to treat cytomegalovirus disease in immunocomprimised patients. Ganciclovir pharmacokinetics in ECMO is unknown.
Case description: A 6-year-old with a stage IV extra-renal rhabdoid tumor with respiratory failure leading to extracorporeal membrane oxygenation had increasing serum CMV DNAemia while on ganciclovir.
What is new and conclusion: This is the first case report of ganciclovir pharmacokinetics in either paediatric or adult ECMO populations. Recommended dosing provided a low, subtherapeutic AUC24 with an associated increase CMV viral load. Higher doses of ganciclovir may be required in ECMO patients, especially without concurrent CRRT.
Keywords: clinical pharmacokinetics; clinical pharmacy; clinicians; pharmacists; pharmacodynamics; pharmacokinetics; therapeutic drug monitoring.
© 2019 John Wiley & Sons Ltd.
Pharmacokinetic changes of antibiotic, antiviral, antituberculosis and antifungal agents during extracorporeal membrane oxygenation in critically ill adult patients.J Clin Pharm Ther. 2017 Dec;42(6):661-671. doi: 10.1111/jcpt.12636. Epub 2017 Sep 25. J Clin Pharm Ther. 2017. PMID: 28948652 Review.
Altered Pharmacokinetics and Dosing of Liposomal Amphotericin B and Isavuconazole during Extracorporeal Membrane Oxygenation.Pharmacotherapy. 2020 Jan;40(1):89-95. doi: 10.1002/phar.2348. Epub 2019 Dec 13. Pharmacotherapy. 2020. PMID: 31742741
Pharmacokinetics and Dosing of Anti-infective Drugs in Patients on Extracorporeal Membrane Oxygenation: A Review of the Current Literature.Clin Ther. 2016 Sep;38(9):1976-94. doi: 10.1016/j.clinthera.2016.07.169. Epub 2016 Aug 21. Clin Ther. 2016. PMID: 27553752 Free PMC article. Review.
Population Pharmacokinetics and Dose Optimization of Teicoplanin during Venoarterial Extracorporeal Membrane Oxygenation.Antimicrob Agents Chemother. 2017 Aug 24;61(9):e01015-17. doi: 10.1128/AAC.01015-17. Print 2017 Sep. Antimicrob Agents Chemother. 2017. PMID: 28674057 Free PMC article.
Therapeutic drug monitoring of continuous-infusion acylovir for disseminated herpes simplex virus infection in a neonate receiving concurrent extracorporeal life support and continuous renal replacement therapy.Pharmacotherapy. 2015 Feb;35(2):229-33. doi: 10.1002/phar.1526. Epub 2014 Dec 29. Pharmacotherapy. 2015. PMID: 25556960
- Nightingale SC. From the food and drug administration. JAMA. 1989;262(6):740.
- Wong DD, van Zuylen WJ, Craig ME, Rawlinson WD. Systematic review of ganciclovir pharmacodynamics during the prevention of cytomegalovirus infection in adult solid organ transplant recipients. Rev Med Virol. 2019;29(2):e2023.
- Luck S, Lovering A, Griffiths P, Sharland M. Ganciclovir treatment in children: evidence of subtherapeutic levels. Int J Antimicrob Agents. 2011;37(5):445-448.
- Vethamuthu J, Feber J, Chretien A, Lampe D, Filler G. Unexpectedly high inter- and intrapatient variability of ganciclovir levels in children. Pediatr Transplant. 2007;11(3):301-305.
- Kim BJ, Jung JW, Shin YR, Park HK, Park YH, Shin HJ. Cytomegalovirus myocarditis required extracorporeal membrane oxygenation support followed by ganciclovir treatment in infant. Korean J Thorac Cardiovasc Surg. 2016;49(3):199-202.