title: Therapeutic drug monitoring of voriconazole helps to decrease the percentage of patients with off-target trough serum levels.
abstract: We monitored trough voriconazole serum concentrations from 107 patients (n = 258 samples) at 6 hospitals in Madrid. Most of the patients were male (67%) and had the following underlying conditions: hematological cancer (42%), solid organ transplantation (15%), chronic obstructive pulmonary disease (14%), human immunodeficiency virus infection (8.4%), solid cancer (5.6%), and other (29%). The indication for voriconazole administration was aspergillosis treatment (74.6%) and prophylaxis (14%). The main reasons for voriconazole trough drug monitoring were initiation of treatment/prophylaxis (33%), patient monitoring (47%), and suspected toxicity (3.5%). Levels (μg/ml) were subtherapeutic (<1; 18.2%), on-target (1-5.5; 71.3%), and high (>5.5; 10.5%). The samples percentage with on-target levels was significantly lower for the first sample than for subsequent samples (62.6% vs. 77.5%). "Subsequent samples," "admission in nonpediatric wards," "voriconazole used for treatment of invasive aspergillosis," and "use of proton pump inhibitors" were predictors of voriconazole therapeutic levels (≥1 μg/ml).
authors.affiliation: Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain Instituto de Investigación Sanitaria del Hospital Gregorio Marañón CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain jguineaortega@yahoo.es.
authors.forename: Jesús
authors.initials: J
authors.lastname: Guinea
authors.affiliation: Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain Instituto de Investigación Sanitaria del Hospital Gregorio Marañón CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Escribano
authors.affiliation: Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain Instituto de Investigación Sanitaria del Hospital Gregorio Marañón.
authors.forename: Laura Judith
authors.initials: LJ
authors.lastname: Marcos-Zambrano
authors.affiliation: Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain Instituto de Investigación Sanitaria del Hospital Gregorio Marañón CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Peláez
authors.affiliation: Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain Instituto de Investigación Sanitaria del Hospital Gregorio Marañón.
authors.forename: Marta
authors.initials: M
authors.lastname: Kestler
authors.affiliation: Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain Instituto de Investigación Sanitaria del Hospital Gregorio Marañón CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Patricia
authors.initials: P
authors.lastname: Muñoz
authors.affiliation: Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain Instituto de Investigación Sanitaria del Hospital Gregorio Marañón.
authors.forename: Antonio
authors.initials: A
authors.lastname: Vena
authors.affiliation: Microbiology Department, Hospital de Móstoles, Madrid, Spain.
authors.forename: Fátima
authors.initials: F
authors.lastname: López-Fabal
authors.affiliation: Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain Instituto de Investigación Sanitaria del Hospital Gregorio Marañón CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Emilio
authors.initials: E
authors.lastname: Bouza
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000008:administration & dosage / Q000097:blood* / Q000493:pharmacokinetics / Q000627:therapeutic use; D001228:Aspergillosis / Q000188:drug therapy; D002648:Child; D002675:Child, Preschool; D002851:Chromatography, High Pressure Liquid; D016903:Drug Monitoring / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D065819:Voriconazole / Q000008:administration & dosage / Q000097:blood* / Q000493:pharmacokinetics / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D065819:Voriconazole
keywords: HPLC; Voriconazole; invasive aspergillosis; off-target; therapeutic drug monitoring