Paediatric ganciclovir dosing in extracorporeal membrane oxygenation: Is standard dosing good enough?
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.
['Murphy|Mark|M|https://orcid.org/0000-0001-6743-6835', 'Chamberlain|Andrea|A|', 'Tang|Peter|P|', 'Turpin|Brian|B|', 'Danziger-Isakov|Lara|L|']
D000998:Antiviral Agents D002648:Child D003586:Cytomegalovirus Infections D004305:Dose-Response Relationship, Drug D015199:Extracorporeal Membrane Oxygenation D015774:Ganciclovir D006801:Humans D008297:Male D009367:Neoplasm Staging D018335:Rhabdoid Tumor
pharmacokinetics clinical pharmacokinetics clinical pharmacy clinicians pharmacists pharmacodynamics therapeutic drug monitoring