Methods: After 6 months, the initial CPG was reviewed and modified to refine TDM recommendations. Adherence to the guideline and ability of the CPG to achieve target voriconazole trough concentrations were assessed before and after the revision. Patients in the analysis included those admitted to a large free-standing children’s hospital and receiving voriconazole for confirmed, probable, or presumed fungal infection from 4/1/2015 to 12/31/2016 (25 subjects, median age 10 years).
Results: The study showed that use of TDM increased following implementation of a CPG from 42% to 100% with improved timing of TDM to reflect concentrations drawn at steady state. Of the patients receiving TDM, achievement of voriconazole concentration in the therapeutic range increased from 70% to 100% with the CPG; however, there was no improvement in the time to reach target concentration. We observed an inability of American Academy of Pediatrics-recommended doses to reach target concentration in 53% of patients, with doses based on pharmacist judgement performing as well as published dosing.
Conclusion: We conclude that a pharmacist-driven voriconazole CPG improved monitoring and achievement of therapeutic concentrations in our children’s hospital. Analysis of effectiveness of our voriconazole CPG in conjunction with pharmacist feedback has been essential to improving patient outcomes and informing future guideline modifications.
P. Havens, None
T. Zembles, None
See more of: Poster Abstract Session