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Review
. 2025 Jan;27(1):41-56.
doi: 10.1007/s40272-024-00663-5. Epub 2024 Nov 6.

Therapeutic Drug Monitoring of Antimicrobial Drugs in Children with Cancer: A New Tool for Personalized Medicine

Riccardo Masetti  1   2 , Gianluca Bossù  3 , Edoardo Muratore  4 , Davide Leardini  4 , Milo Gatti  5 , Riccardo Di Sario  3 , Federico Pea  5 , Susanna Esposito  3
Affiliations
Review

Therapeutic Drug Monitoring of Antimicrobial Drugs in Children with Cancer: A New Tool for Personalized Medicine

Riccardo Masetti et al. Paediatr Drugs. 2025 Jan.

Abstract

The risk of fungal, bacterial, and viral infections is higher in children with hematological and solid malignancies, particularly during periods of profound neutropenia. Although early administration of antimicrobial agents is common, optimizing pharmacological therapy in pediatric patients with cancer is challenging because of their variable pharmacokinetics compared with adults, including differences in body mass and augmented renal clearance, as well as chemotherapy-induced organ toxicity. Therapeutic drug monitoring, which involves measuring drug concentrations in serum or plasma at specific timepoints and adjusting doses accordingly, can be applied to various medications. While standardized targets for all antimicrobial agents in children are lacking, therapeutic drug monitoring appears to be beneficial in preventing serious toxicity and addressing treatment failure or non-compliance. This narrative review aims to analyze current perspectives on therapeutic drug monitoring for antimicrobial drugs in the special population of children with hematological or oncological diseases, including those undergoing hematopoietic cell transplantation. The review provides evidence on the clinical benefits of this method and explores potential future developments in this area.

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Conflict of interest statement

Declarations. Funding: This work was supported by a grant from the Pediatric Clinic, Department of Medicine and Surgery, University of Parma, Parma, Italy. Conflicts of Interest/Competing Interests: Riccardo Masetti, Gianluca Bossù, Edoardo Muratore, Davide Leardini, Milo Gatti, Riccardo Di Sario, Federico Pea, and Susanna Esposito have no competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Susanna Esposito is an Editorial Board member of Pediatric Drugs. Professor Esposito was not involved in the selection of peer reviewers for the manuscript nor any of the subsequent editorial decisions. Ethics Approval: Not applicable. Consent to Participate: Not applicable. Consent for Publication: Not applicable. Availability of Data and Material: Not applicable. Code Availability: Not applicable. Authors’ Contributions: RM: conceptualization, resources, investigation, writing (original draft, review and editing); GB: resources, investigation, writing (original draft); EM: resources, investigation, writing (original draft); DL: resources, investigation, writing (original draft); MG: writing (review and editing); RDS: resources, investigation, writing (original draft): FP: writing (review and editing); SE: conceptualization, resources, funding acquisition, writing (review and editing).

References

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