Role of Therapeutic Drug Monitoring: Candidiasis


Two large trials investigated the role of voriconazole in patients with candidiasis. The first, a non-inferiority study, enrolled 391 immunocompromised adult patients with esophageal candidiasis, who were randomly assigned to receive either voriconazole or fluconazole as oral therapy. On the basis of a per-protocol population analysis at the end of therapy, oral voriconazole was non-inferior to fluconazole in terms of treatment success rate (defined as patients with cure or improvement, as determined by esophagoscopy).

The second study, a randomized, multicentre, nonblinded, non-inferiority trial, compared voriconazole with amphotericin B for the treatment of invasive candidiasis in 422 non- neutropenic patients.45 A modified intention-to-treat analysis showed no significant difference between the 2 groups in terms of the primary end point for efficacy, success rate at 12 weeks after the end of therapy. Adverse renal events were significantly lower in the voriconazole group than in the amphotericin B group (8% versus 91%, p = 0.0002), as were chills (3% versus 8%, p = 0.03). suhagra

Treatment of Rare Fungal Infections and/or Salvage Therapy

The efficacy of voriconazole as treatment for refractory or rare invasive fungal infections has been documented in several case reports and small observational studies. The largest trial evaluating voriconazole for this indication was an open, noncomparative, multicentre study conducted by Perfect and others. A total of 301 patents were enrolled, the majority of whom were immunocompromised and received voriconazole as salvage therapy. The efficacy rates (defined as a global response based on a composite of clinical, mycological, radiological, and serological responses) were 43.7% for aspergillosis, 57.5% for candidiasis, 38.9% for cryptococcosis, 45.5% for fusariosis, and 30% for scedosporiosis. A smaller observational study evaluating voriconazole as salvage therapy for refractory invasive candidiasis reported similar response rates.

Empiric Therapy in Fever and Neutropenia

At present, voriconazole is not indicated for empiric use in patients with neutropenia, primarily because of a non-inferiority trial that had a significantly higher proportion of discontinua­tion in the group receiving voriconazole (secondary to lack of response to therapy) than in the group receiving liposomal amphotericin B. However, diagnostic tools have improved since publication of the original study, and future diagnostic techniques may allow more rapid identification of patients with neutropenia who are at risk of aspergillosis and who may benefit from empiric treatment with voriconazole. Cialis Jelly

Category: Drugs

Tags: antifungal, invasive fungal infection, pharmacokinetics, therapeutic drug monitoring, voriconazole

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