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Evaluation of Voriconazole and Posaconazole Dosing in Patients With Thermal Burn Injuries
Kaitlin L Musick1, Savannah L Jones1, Ashlyn M Norris1
1Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, USA.
Abstract:
Fungal infections are a recognized cause of increased morbidity and mortality in thermal burn patients. Adequate treatment regimens remain a challenge due to unpredictable pharmacokinetic/pharmacodynamic changes caused by a hypermetabolic state and individual patient factors. A retrospective evaluation of adult thermal burn patients from April 2014 to April 2020 was conducted to assess voriconazole and posaconazole antifungal dosing regimens. The primary outcome was the incidence of attaining a therapeutic steady-state trough level on the patient's initial voriconazole or posaconazole regimen. Of the 33 patients analyzed, 26 (78.8%) patients achieved a therapeutic level during azole therapy. However, only 11 (33.3%) patients achieved a therapeutic level on their first azole regimen. The median time to therapeutic level was 8.0 + 21.8 days from the start of azole therapy. Optimal dosing strategies for azole therapy in patients with thermal burns remain undefined. Further assessment is needed to delineate patient-specific factors that can contribute to subtherapeutic azole levels in thermal burn patients and the overall clinical impact of population-specific dosing regimens.
Insights
Achieving therapeutic levels of voriconazole and posaconazole in burn patients is challenging. Many patients require dose adjustments to reach effective antifungal drug concentrations.
Area of Science:
- Medical Mycology
- Pharmacology
- Burn Critical Care
Background:
- Fungal infections pose significant risks to burn patients, increasing morbidity and mortality.
- Managing these infections is complicated by altered drug metabolism in the hypermetabolic state common in burn survivors.
Purpose of the Study:
- To evaluate voriconazole and posaconazole dosing regimens in adult thermal burn patients.
- To determine the incidence of achieving therapeutic drug levels on initial antifungal regimens.
Main Methods:
- Retrospective analysis of adult burn patients treated between April 2014 and April 2020.
- Assessment of voriconazole and posaconazole steady-state trough levels.
Main Results:
- 26 out of 33 patients (78.8%) eventually achieved therapeutic azole levels.
- Only 11 out of 33 patients (33.3%) reached therapeutic levels with their initial regimen.
- Median time to achieve therapeutic levels was 8.0 ± 21.8 days.
Conclusions:
- Current azole dosing strategies for thermal burn patients are not consistently effective.
- Further research is needed to identify patient-specific factors influencing drug levels and optimize dosing regimens.
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