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Pharmacokinetic Variability and Target Attainment of Fluconazole in Critically Ill Patients
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...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8538061/ https://www.ncbi.nlm.nih.gov/pubmed/34683388 http://dx.doi.org/10.3390/microorganisms9102068 |
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author | Van Daele, Ruth Wauters, Joost Lagrou, Katrien Denooz, Raphaël Hayette, Marie-Pierre Gijsen, Matthias Brüggemann, Roger J. Debaveye, Yves Spriet, Isabel |
author_facet | Van Daele, Ruth Wauters, Joost Lagrou, Katrien Denooz, Raphaël Hayette, Marie-Pierre Gijsen, Matthias Brüggemann, Roger J. Debaveye, Yves Spriet, Isabel |
author_sort | Van Daele, Ruth |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-8538061 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-85380612021-10-24 Pharmacokinetic Variability and Target Attainment of Fluconazole in Critically Ill Patients Van Daele, Ruth Wauters, Joost Lagrou, Katrien Denooz, Raphaël Hayette, Marie-Pierre Gijsen, Matthias Brüggemann, Roger J. Debaveye, Yves Spriet, Isabel Microorganisms Article 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. MDPI 2021-09-30 /pmc/articles/PMC8538061/ /pubmed/34683388 http://dx.doi.org/10.3390/microorganisms9102068 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Van Daele, Ruth Wauters, Joost Lagrou, Katrien Denooz, Raphaël Hayette, Marie-Pierre Gijsen, Matthias Brüggemann, Roger J. Debaveye, Yves Spriet, Isabel Pharmacokinetic Variability and Target Attainment of Fluconazole in Critically Ill Patients |
title | Pharmacokinetic Variability and Target Attainment of Fluconazole in Critically Ill Patients |
title_full | Pharmacokinetic Variability and Target Attainment of Fluconazole in Critically Ill Patients |
title_fullStr | Pharmacokinetic Variability and Target Attainment of Fluconazole in Critically Ill Patients |
title_full_unstemmed | Pharmacokinetic Variability and Target Attainment of Fluconazole in Critically Ill Patients |
title_short | Pharmacokinetic Variability and Target Attainment of Fluconazole in Critically Ill Patients |
title_sort | pharmacokinetic variability and target attainment of fluconazole in critically ill patients |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8538061/ https://www.ncbi.nlm.nih.gov/pubmed/34683388 http://dx.doi.org/10.3390/microorganisms9102068 |
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