title: Voriconazole Therapeutic Drug Monitoring Practices in Intensive Care.
abstract: Routine therapeutic drug monitoring of voriconazole seems to be beneficial. This study investigated the therapeutic drug monitoring practices in intensive care to derive possible recommendations for improvement.
  
  
  
  A retrospective chart review was performed for patients aged ≥18 years who started treatment with voriconazole, which lasted for at least 3 days while being admitted to an intensive care unit to assess possible differences between the patients with and without voriconazole trough concentrations measured.
  
  
  
  In 64 (76%) of the 84 patients, voriconazole trough concentrations were measured. The groups differed significantly with respect to the duration of voriconazole treatment and intensive care unit admission. Time of sampling was very early and therefore inappropriate for 49% of the first measured voriconazole trough concentrations and in 48% of the subsequent measured concentrations. Of the 349 trough concentrations measured, 129 (37%) were outside the therapeutic window. In 11% of these cases, no recommendation was provided without identifiable reason. In addition, 27% of recommended dose adjustments were not implemented, probably because the advice was not suited for the specific clinical situation.
  
  
  
  The performance of voriconazole therapeutic drug monitoring can still be improved although voriconazole concentrations were monitored in most patients. A multidisciplinary approach-for instance by means of antifungal stewardship-will probably be able to overcome problems encountered such as timing of sampling, incompleteness of data in clinical context, and lack of implementation of recommendations.
authors: *University of Groningen, University Medical Center Groningen, Department of Clinical Pharmacy and Pharmacology, †University of Groningen, University Medical Center Groningen, Department of Critical Care, and ‡University of Groningen, University Medical Center Groningen, Department of Hematology; §University of Groningen, University Medical Center Groningen, Division of Pharmacotherapy and Pharmaceutical Care, Department of Pharmacy; and ¶University of Groningen, University Medical Center Groningen, Departments of Internal Medicine and Pulmonary Diseases and Tuberculosis, the Netherlands.
authors: Marjolijn J P
authors: MJ
authors: van Wanrooy
authors: Michael G G
authors: MG
authors: Rodgers
authors: Lambert F R
authors: LF
authors: Span
authors: Jan G
authors: JG
authors: Zijlstra
authors: Donald R A
authors: DR
authors: Uges
authors: Jos G W
authors: JG
authors: Kosterink
authors: Tjip S
authors: TS
authors: van der Werf
authors: Jan-Willem C
authors: JW
authors: Alffenaar
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000008:administration & dosage / Q000493:pharmacokinetics*; D003422:Critical Care; D004305:Dose-Response Relationship, Drug; D016903:Drug Monitoring / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D065819:Voriconazole / Q000008:administration & dosage / Q000493:pharmacokinetics*
chemical_list: D000935:Antifungal Agents; D065819:Voriconazole