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Article

Valganciclovir—Ganciclovir Use and Systematic Therapeutic Drug Monitoring. An Invitation to Antiviral Stewardship

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Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo 46, 28007 Madrid, Spain
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Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain
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Pharmacy Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
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Cardiology Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
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Nephrology Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
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CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), 28029 Madrid, Spain
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Medicine Department, School of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
*
Authors to whom correspondence should be addressed.
Received: 22 November 2020 / Revised: 7 January 2021 / Accepted: 11 January 2021 / Published: 15 January 2021
(This article belongs to the Section Antibiotics Use and Antimicrobial Stewardship)
Valganciclovir (VGCV) and ganciclovir (GCV) doses must be adjusted according to indication, renal function and weight. No specific therapeutic exposure values have been established. We aimed to evaluate the adequacy of VGCV/GCV doses, to assess the interpatient variability in GCV serum levels, to identify predictive factors for this variability and to assess the clinical impact. This is a prospective study at a tertiary institution including hospitalized patients receiving VGCV/GCV prophylaxis or treatment. Adequacy of the antiviral dose was defined according to cytomegalovirus guidelines. Serum levels were determined using High-Performance Liquid Chromatography. Blood samples were drawn at least 3 days after antiviral initiation. Outcome was considered favorable if there was no evidence of cytomegalovirus infection during prophylaxis or when a clinical and microbiological resolution was attained within 21 days of treatment and no need for drug discontinuation due to toxicity. Seventy consecutive patients [74.3% male/median age: 59.2 years] were included. VGCV was used in 25 patients (35.7%) and GCV in 45 (64.3%). VGCV/GCV initial dosage was deemed adequate in 47/70 cases (67.1%), lower than recommended in 7/70 (10%) and higher in 16/70 (22.9%). Large inter-individual variability of serum levels was observed, with median trough levels of 2.3 mg/L and median peak levels of 7.8 mg/L. Inadequate dosing of VGCV/GCV and peak levels lower than 8.37 or greater than 11.86 mg/L were related to poor outcome. Further studies must be performed to confirm these results and to conclusively establish if VGCV/GCV therapeutic drug monitoring could be useful to improve outcomes in specific clinical situations. View Full-Text
Keywords: valganciclovir; ganciclovir; serum levels; therapeutic drug monitoring; CMV infection valganciclovir; ganciclovir; serum levels; therapeutic drug monitoring; CMV infection
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MDPI and ACS Style

Galar, A.; Valerio, M.; Catalán, P.; García-González, X.; Burillo, A.; Fernández-Cruz, A.; Zataráin, E.; Sousa-Casasnovas, I.; Anaya, F.; Rodríguez-Ferrero, M.L.; Muñoz, P.; Bouza, E. Valganciclovir—Ganciclovir Use and Systematic Therapeutic Drug Monitoring. An Invitation to Antiviral Stewardship. Antibiotics 2021, 10, 77. https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics10010077

AMA Style

Galar A, Valerio M, Catalán P, García-González X, Burillo A, Fernández-Cruz A, Zataráin E, Sousa-Casasnovas I, Anaya F, Rodríguez-Ferrero ML, Muñoz P, Bouza E. Valganciclovir—Ganciclovir Use and Systematic Therapeutic Drug Monitoring. An Invitation to Antiviral Stewardship. Antibiotics. 2021; 10(1):77. https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics10010077

Chicago/Turabian Style

Galar, Alicia, Maricela Valerio, Pilar Catalán, Xandra García-González, Almudena Burillo, Ana Fernández-Cruz, Eduardo Zataráin, Iago Sousa-Casasnovas, Fernando Anaya, María L. Rodríguez-Ferrero, Patricia Muñoz, and Emilio Bouza. 2021. "Valganciclovir—Ganciclovir Use and Systematic Therapeutic Drug Monitoring. An Invitation to Antiviral Stewardship" Antibiotics 10, no. 1: 77. https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics10010077

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