Program Schedule

Voriconazole Restriction in Addition to Therapeutic Drug Monitoring (TDM) Protocol Results in Optimized Dosing

Session: Poster Abstract Session: Antibiotic Stewardship
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background: Voriconazole (VRC) is a broad spectrum antifungal with activity against several medically important pathogens including Candida spp. and  Aspergillus spp., often utilized as a prophylactic agent in high risk patient populations and in the management of invasive fungal infections.  VRC TDM is recommended by national guidelines to ensure safety and efficacy, with a recommended therapeutic trough range of 2-5.5 mcg/dL.  We previously found, prior to the implementation of a TDM protocol in addition to antimicrobial stewardship (ASP) restriction and post-prescriptive review for all patients receiving therapeutic VRC, only 44% of patients achieved adequate troughs.  We sought to evaluate our success rate with achieving therapeutic trough concentrations (TTC) following the implementation of a TDM protocol in addition to targeted ASP restriction and monitoring efforts.

Methods: All adult inpatients receiving therapeutic voriconazole for either presumed or documented invasive fungal infections, with a serum trough concentration obtained between 10/20/2012-7/23/2013 were included in this analysis.  Patients that received voriconazole for prophylaxis were excluded.

Results: Twenty-five adult inpatients receiving therapeutic VRC had a serum trough concentration obtained.  80% of patients were found to have a TTC with a median trough of 4.3 mcg/dL.  Among patients that received a loading dose (N=19), 89.4% of patients achieved a TTC.  Of those that did not receive a loading dose (N=6), only 50% achieved a TTC. Trough concentrations were obtained on day 5 of therapy (median). 

Conclusion: Following the implementation of a VRC TDM protocol in addition to concerted efforts by ASP in ensuring safe and appropriate utilization, rate of success in achieving TTC increased by 36-45.4%.  Patients receiving a loading dose were more likely to achieve TTC on day 5 of therapy.

Natasha Pettit, PharmD1, Zhe Han, PharmD2, Mildred Vicente, PharmD2, Emily Landon, MD3, Jennifer Pisano, MD3 and Allison H. Bartlett, MD, MS4, (1)Pharmacy Services, University of Chicago Medicine, Chicago, IL, (2)Pharmacy Services, The University of Chicago Medicine, Chicago, IL, (3)Infectious Diseases and Global Health, The University of Chicago Medicine, Chicago, IL, (4)Pediatrics (Infectious Diseases), University of Chicago Medicine, Chicago, IL


N. Pettit, None

Z. Han, None

M. Vicente, None

E. Landon, None

J. Pisano, Pfizer: Grant Investigator, Research grant

A. H. Bartlett, None

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