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Voriconazole Therapeutic Drug Monitoring Practices in Intensive Care
Marjolijn J P van Wanrooy1, Michael G G Rodgers, Lambert F R Span
1*University of Groningen, University Medical Center Groningen, Department of Clinical Pharmacy and Pharmacology, †University of Groningen, University Medical Center Groningen, Department of Critical Care, and ‡University of Groningen, University Medical Center Groningen, Department of Hematology; §University of Groningen, University Medical Center Groningen, Division of Pharmacotherapy and Pharmaceutical Care, Department of Pharmacy; and ¶University of Groningen, University Medical Center Groningen, Departments of Internal Medicine and Pulmonary Diseases and Tuberculosis, the Netherlands.
Background:
Routine therapeutic drug monitoring of voriconazole seems to be beneficial. This study investigated the therapeutic drug monitoring practices in intensive care to derive possible recommendations for improvement.
Methods:
A retrospective chart review was performed for patients aged ≥18 years who started treatment with voriconazole, which lasted for at least 3 days while being admitted to an intensive care unit to assess possible differences between the patients with and without voriconazole trough concentrations measured.
Results:
In 64 (76%) of the 84 patients, voriconazole trough concentrations were measured. The groups differed significantly with respect to the duration of voriconazole treatment and intensive care unit admission. Time of sampling was very early and therefore inappropriate for 49% of the first measured voriconazole trough concentrations and in 48% of the subsequent measured concentrations. Of the 349 trough concentrations measured, 129 (37%) were outside the therapeutic window. In 11% of these cases, no recommendation was provided without identifiable reason. In addition, 27% of recommended dose adjustments were not implemented, probably because the advice was not suited for the specific clinical situation.
Conclusions:
The performance of voriconazole therapeutic drug monitoring can still be improved although voriconazole concentrations were monitored in most patients. A multidisciplinary approach-for instance by means of antifungal stewardship-will probably be able to overcome problems encountered such as timing of sampling, incompleteness of data in clinical context, and lack of implementation of recommendations.
Insights
Therapeutic drug monitoring of voriconazole in intensive care units (ICUs) shows room for improvement. Key issues include inappropriate sampling times and a lack of recommendation implementation, highlighting the need for a multidisciplinary approach.
Area of Science:
- Pharmacology
- Critical Care Medicine
- Clinical Pharmacy
Background:
- Routine therapeutic drug monitoring (TDM) of voriconazole is considered beneficial.
- Voriconazole TDM practices in intensive care units (ICUs) require investigation for potential improvements.
Purpose of the Study:
- To investigate voriconazole TDM practices in ICUs.
- To derive recommendations for enhancing voriconazole TDM in critical care settings.
Main Methods:
- Retrospective chart review of adult patients receiving voriconazole for ≥3 days in an ICU.
- Comparison of patients with and without measured voriconazole trough concentrations.
Main Results:
- Voriconazole trough concentrations were measured in 76% of patients.
- Inappropriate sampling times affected nearly half of all measurements.
- 37% of measured concentrations were outside the therapeutic window, with implementation challenges for dose adjustments.
Conclusions:
- Voriconazole TDM performance in ICUs can be enhanced.
- A multidisciplinary approach, such as antifungal stewardship, is recommended to address issues like sampling timing and recommendation implementation.
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