Clinical Pharmacokinetics and Dose Recommendations for Posaconazole in Infants and Children.

OBJECTIVES: The objectives of this study were to investigate the population pharmacokinetics of posaconazole in immunocompromised children, evaluate the influence of patient characteristics on posaconazole exposure and perform simulations to recommend optimal starting doses. METHODS: Posaconazole plasma concentrations from paediatric patients undergoing therapeutic drug monitoring were extracted from a tertiary paediatric hospital database. These were merged with covariates collected from electronic sources and case-note reviews. An allometrically scaled population-pharmacokinetic model was developed to investigate the effect of tablet and suspension relative bioavailability, nonlinear bioavailability of suspension, followed by a step-wise covariate model building exercise to identify other important sources of variability. RESULTS: A total of 338 posaconazole plasma concentrations samples were taken from 117 children aged 5 months to 18 years. A one-compartment model was used, with tablet apparent clearance standardised to a 70-kg individual of 15 L/h. Suspension was found to have decreasing bioavailability with increasing dose; the estimated suspension dose to yield half the tablet bioavailability was 99 mg/m2. Diarrhoea and proton pump inhibitors were also associated with reduced suspension bioavailability. CONCLUSIONS: In the largest population-pharmacokinetic study to date in children, we have found similar covariate effects to those seen in adults, but low bioavailability of suspension in patients with diarrhoea or those taking concurrent proton pump inhibitors, which may in particular limit the use of posaconazole in these patients

Palynological analysis of Dennstaedtiaceae taxa from the Paranaense Phytogeographic Province that produce Trilete spores II: Microlepia speluncae and Pteridium arachnoideum

The spore morphology and wall ultrastructure of Microlepia speluncae and Pteridium arachnoideum from the Paranaense Province were analyzed with LM, SEM and TEM and a comparative analysis was carried out. In both species the spores are covered by a three-dimensional network of threads branched and fused, tangentially arranged to the surface, and some free-end threads are also seen. The species were differentiated by morphology and the frequency of threads fusion and the networks distribution on the surface of the spores. In both species the exospore is two-layered in section, both layers are traversed by single or branched channels. The perispore is three-layered in section: the inner layer is adhered to the exospore, the middle layer is formed of a three-dimensional network of threads and the outer layer is discontinuous. The perispore ultrastructure of Microlepia speluncae was interpreted as formed of helical subunits displayed around a central channel. The spore morphology and perispore ultrastructure allow differentiating Microlepia from Pteridium but also to the other Dennstaedtiaceae genera that grow in the Paranaense Province. The results obtained allow establishing relationships that let us recognize different groups and gave a new reference to get a better knowledge of the family