Background: Voriconazole (VRC) is a new standard for treatment of invasive fungal infections (IFI). Inter-individual variability of VRC blood levels has been described. Recent reports suggest that low blood levels might be associated with failure of VRC therapy (Rx). Objective: To assess the utility of documentation of low VRC blood levels followed by dose adjustment in patients (Pts) not responding to Rx. Methods: Retrospective analysis of Pts receiving VRC for proven or probable IFI (EORTC-BAMSG) over 2004-2006. Definitions: success = partial or complete resolution, failure = persistent or progressing IFI. Failure in with a VRC trough level 8804;1 mg/L (MIC90 of the most fungal pathogens) was the trigger for dose adjustment. Results: 37 Pts. Median age: 60 (23 to 78). 68% had aspergillosis, 22% candidiasis and 10% other IFI. Median VRC dose: 8 mg/kg/d for a median duration of 50 days. Table Among 6 Pts with VRC failure and trough levels 8804;1 mg/L, 4 had proven (MIC of VRC 1 mg/L responded to salvage Rx. Conclusions: Documentation of low VRC blood levels followed by dose increase may improve outcome in Pts with invasive fungal infections not responding to Rx.
Full conference title:
46th Interscience Conference on Antimicrobial Agents and Chemotherapy
- ICAAC 46th