[Role of voriconazole in critically ill patients with invasive mycoses]

This observational study of the use of voriconazole conducted in Spain has identified reasons, characteristics, and forms of use of voriconazole in critically ill patients admitted to the ICU. Voriconale was used for directed treatment (63%), by the intravenous route (75%), as rescue treatment (41%) in severely ill patients (APACHE 21) with high need of resources and therapeutic interventions. Satisfactory clinical response was obtained in 50% of cases, related adverse events were scarce (16%), and withdrawal of voriconazole was not necessary. Clinical indications included empirical, etiologic, and rescue treatment of infections caused by Aspergillus, Candida albicans and most species different than C. albicans. Voriconazole can be used for preemptive therapy in patients at risk of invasive candidasis. When selecting voriconazole, liver function, renal function (i.v. formulation) and history of azoles use should be considered, although none of these circumstances is an absolute contraindication for the prescription of voriconazole in critically ill patients.