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Med Mycol. 2016 May;54(4):353-60. doi: 10.1093/mmy/myv099. Epub 2016 Jan 6.

Therapeutic drug monitoring of voriconazole helps to decrease the percentage of patients with off-target trough serum levels.

Author information

1
Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain Instituto de Investigación Sanitaria del Hospital Gregorio Marañón CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain jguineaortega@yahoo.es.
2
Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain Instituto de Investigación Sanitaria del Hospital Gregorio Marañón CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain.
3
Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain Instituto de Investigación Sanitaria del Hospital Gregorio Marañón.
4
Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain Instituto de Investigación Sanitaria del Hospital Gregorio Marañón CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
5
Microbiology Department, Hospital de Móstoles, Madrid, Spain.

Abstract

We monitored trough voriconazole serum concentrations from 107 patients (n = 258 samples) at 6 hospitals in Madrid. Most of the patients were male (67%) and had the following underlying conditions: hematological cancer (42%), solid organ transplantation (15%), chronic obstructive pulmonary disease (14%), human immunodeficiency virus infection (8.4%), solid cancer (5.6%), and other (29%). The indication for voriconazole administration was aspergillosis treatment (74.6%) and prophylaxis (14%). The main reasons for voriconazole trough drug monitoring were initiation of treatment/prophylaxis (33%), patient monitoring (47%), and suspected toxicity (3.5%). Levels (μg/ml) were subtherapeutic (<1; 18.2%), on-target (1-5.5; 71.3%), and high (>5.5; 10.5%). The samples percentage with on-target levels was significantly lower for the first sample than for subsequent samples (62.6% vs. 77.5%). "Subsequent samples," "admission in nonpediatric wards," "voriconazole used for treatment of invasive aspergillosis," and "use of proton pump inhibitors" were predictors of voriconazole therapeutic levels (≥1 μg/ml).

KEYWORDS:

HPLC; Voriconazole; invasive aspergillosis; off-target; therapeutic drug monitoring

PMID:
26739190
DOI:
10.1093/mmy/myv099
[Indexed for MEDLINE]

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