Abstract
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 patients. 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 predefined target trough concentrations.
Highlights
Fluconazole is one of the oldest antifungal drugs and is used for the treatment of invasive candidiasis and candidaemia
March 2020 in the University Hospitals Leuven were eligible for inclusion in this prospective, observational PK study, irrespective of timing of fluconazole initiation, provided that there were no therapeutic restrictions and written informed consent was obtained from the patient or their relatives
288 fluconazole trough concentrations were included in this analysis, with a median (IQR) trough concentration of 22.9 (14.7–35.2) mg/L
Summary
Fluconazole is one of the oldest antifungal drugs and is used for the treatment of invasive candidiasis and candidaemia. Despite the extensive experience with this drug in clinical practice, at intensive care units (ICUs), few data are available concerning exposure and target attainment (TA). Since fluconazole is predominantly renally excreted as an unchanged drug (80%) via glomerular filtration, followed by tubular reabsorption, alterations in renal function can influence fluconazole exposure [1]. Renal function can be expressed based on measured 24 h urinary creatinine clearance (CrCL24h ) or via formulae that estimate the glomerular filtration rate (eGFR). Previous studies have raised concerns considering variability in exposure and inadequate target attainment in critically ill patients. The current study aims to define variability and target attainment for fluconazole exposure in a large group of critically ill patients. A notable component of the measured concentrations was below the target trough concentrations
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