Pharmacokinetic variability and target attainment of fluconazole in critically ill patients

Ruth Van Daele, Joost Wauters, Katrien Lagrou, Raphaël Denooz, Marie Pierre Hayette, Matthias Gijsen, Roger J. Brüggemann, Yves Debaveye, Isabel Spriet

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Samenvatting

Background: Fluconazole is one of the oldest antifungal drugs. Previous studies have raised concerns considering variability in exposure and inadequate target attainment in critically ill pa-tients. The current study aims to define variability and target attainment for fluconazole exposure in a large group of critically ill patients. Methods: In this pharmacokinetic study, daily plasma trough samples and, if possible, 24 h urine samples were collected to determine fluconazole concentration. A minimum target trough concentration of 10–15 mg/L was selected, corresponding to a free area under the concentration–time curve above the minimum inhibitory concentration (fAUC/MIC) of at least 100 for an MIC of 4 mg/L. Covariates that significantly influenced fluconazole exposure were identified. Results: In total, 288 plasma samples from 43 patients, with a median age of 66 years, were included. The median fluconazole trough concentration was 22.9 mg/L. A notable component of the measured concentrations was below the target trough concentrations (13% <10 mg/L and 27% <15 mg/L). The intra-and intersubject variability were 28.3% and 50.5%, respectively. The main covariates determining fluconazole exposure were the administered dose (mg/kg), augmented renal clearance, and renal replacement therapy. Conclusions: Fluconazole trough concentrations are variable in critically ill patients and a considerable number of these concentrations was below the pre-defined target trough concentrations.

Originele taal-2Engels
Artikelnummer2068
TijdschriftMicroorganisms
Volume9
Nummer van het tijdschrift10
DOI's
StatusGepubliceerd - okt. 2021
Extern gepubliceerdJa

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