Fluconazole is a synthetic triazole antimycotic agent that is well tolerated with a low incidence of side eects. It is not currently licensed for use in burn patients in the UK but we would like to draw attention to its pharmacokinetics, by way of a case treated at Roehampton. An eighteen year old previously healthy female was involved in a road trac accident in which her car was shunted sideways into a fence. A wooden stave pierced the vehicle, penetrating her right thigh and exiting in her left ank. This resulted in a fractured pelvis, perforated bladder and rectum, and avulsed right ureter. A subsequent ®re resulted in 35% total body surface area (TBSA) burns to her legs and abdomen. Emergency surgery performed at a local hospital consisted of left iliac fossa end colostomy, repair of right ureter, packing of thigh and back wounds and fasciotomies and escharotomies of both legs. Four days later she was stable enough to be transferred to our burns unit. She weighed 62 kg on admission and was on Cefuroxime 750 mg tds, Metronidazole 500 mg tds and Gentamicin 180 mg tds. Over the next few weeks she had multiple general anaesthetics for excision and grafting of her burns. She remained pyrexial despite appropriate therapy for a documented gram-negative bacteraemia. Candida albicans was isolated from raw areas on her legs and empirical antifungal therapy was initiated with intravenous uconazole 400 mg once daily and topical nystatin to her leg wounds. She received a total of 10 days of uconazole therapy and her temperature and general condition gradually improved. Trough uconazole levels were determined by taking blood samples just prior to her regular dose. These were reported as 2.96 mg/L and 3.91 mg/L on day 2 and day 7 respectively. This compares with published data in healthy volunteers of 4 mg/L on day 2 and 10.8 mg/L in day 7 [1]. We conclude that this discrepancy is the result of altered pharmacokinetics due to the burn injury and we therefore do not attribute the improvement in her condition solely to the use of uconazole. It is debatable what the therapeutic antifungal levels should be but they are normally quoted as at least ten times the minimal inhibitory concentration (MIC), which for uconazole is 00.4 mg/L for most candida albicans isolates [1]. Plasma peak levels are reached within two hours, and a steady state, of up to two and a half times the initial plasma level, is achieved in seven days [2]. Burn patients undergo profound physiological changes that produce signi®cant alteration in drug pharmacokinetics. In studies of antibiotic therapy, a decrease in t1/2 has been shown, together with an increase in drug clearance, outside of the resuscitation period [3,4]. All critically ill patients are at risk of fungal infections, be it acquired or endogenous, following treatment with broad spectrum antibiotics [5]. The choice of antifungal agent between amphotericin B and uconazole is debatable [6,7]. There is little information on the pharmacokinetics of uconazole in burns patients, but the limited available data tends to support the practice of individual tailoring of doses [4]. Our patient was critically ill, had a large surface area burn and was on broad-spectrum antibiotics, all risk factors for fungal infection. She received the recommended daily dose for immunocompromised adult patients (P®zer) of 400 mg daily, (6.5 mg/kg/day), but Burns 26 (2000) 109±110