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Clinical Therapeutics

Inflammation Is Associated with Voriconazole Trough Concentrations

Marjolijn J. P. van Wanrooy, Lambert F. R. Span, Michael G. G. Rodgers, Edwin R. van den Heuvel, Donald R. A. Uges, Tjip S. van der Werf, Jos G. W. Kosterink, Jan-Willem C. Alffenaar
Marjolijn J. P. van Wanrooy
aUniversity of Groningen, University Medical Center Groningen, Department of Clinical Pharmacy and Pharmacology, Groningen, The Netherlands
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Lambert F. R. Span
bUniversity of Groningen, University Medical Center Groningen, Department of Hematology, Groningen, The Netherlands
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Michael G. G. Rodgers
cUniversity of Groningen, University Medical Center Groningen, Department of Critical Care, Groningen, The Netherlands
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Edwin R. van den Heuvel
dUniversity of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, The Netherlands
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Donald R. A. Uges
aUniversity of Groningen, University Medical Center Groningen, Department of Clinical Pharmacy and Pharmacology, Groningen, The Netherlands
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Tjip S. van der Werf
eUniversity of Groningen, University Medical Center Groningen, Departments of Internal Medicine and Pulmonary Diseases & Tuberculosis, Groningen, The Netherlands
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Jos G. W. Kosterink
aUniversity of Groningen, University Medical Center Groningen, Department of Clinical Pharmacy and Pharmacology, Groningen, The Netherlands
fUniversity of Groningen, Department of Pharmacy, Division of Pharmacotherapy and Pharmaceutical Care, Groningen, The Netherlands
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Jan-Willem C. Alffenaar
aUniversity of Groningen, University Medical Center Groningen, Department of Clinical Pharmacy and Pharmacology, Groningen, The Netherlands
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DOI: 10.1128/AAC.03820-14
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    FIG 1

    Box (median and 25th to 75th percentiles) and whisker (5th and 95th percentiles) plots of voriconazole trough concentrations for patients with no to mild inflammation (n = 48), moderate inflammation (n = 60), and severe inflammation (n = 20). The filled circles represent outliers. The median (interquartile range [IQR]) voriconazole dose (in mg/kg of body weight) for each group is displayed above each box-and-whisker plot. The dotted lines represent the therapeutic window of voriconazole trough concentrations.

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    FIG 2

    Voriconazole trough concentrations (solid curve) and CRP concentrations (dashed curve) of a 46-year-old male patient with cystic fibrosis who was admitted to the intensive care unit with respiratory insufficiency and was treated with voriconazole after Aspergillus fumigatus was isolated from his respiratory secretions. On day 24, the patient received a bilateral lung transplant. The dotted lines represent the therapeutic window of voriconazole.

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  • TABLE 1

    Patient characteristicsa

    CharacteristicNo. (%) of patients or median (IQR)
    Demographic
        Gender (female)59 (46)
        Age (yr)55 (42–62)
        Weight (kg)75 (61–85)
        Height (m)1.75 (1.67–1.81)
        BMIb (kg/m2)24.2 (21.6–26.6)
    Underlying disease
        Hematologic malignancy67 (52)
        Solid organ transplant34 (27)
        Otherc27 (21)
    Voriconazole treatment
        Twice-daily dose (mg/kg)3.3 (2.6–3.9)
        Intravenous administration64 (50)
    Laboratory parameter
        Voriconazole (mg/liter)2.7 (1.3–4.8)
        CRP (mg/liter)71 (15–152)
        Alkaline phosphatase (U/liter)114 (71–192)
        ALT (U/liter)36 (17–69)
        AST (U/liter)31 (19–61)
        γ-Glutamyl transferase (U/liter)105 (55–232)
        Total bilirubin (μmol/liter)9 (6–16)
    Coadministered medication
         (Es)omeprazole81 (63)
    • ↵a n = 128.

    • ↵b BMI, body mass index.

    • ↵c Other diagnosed diseases included chronic pulmonary obstructive disease, cystic fibrosis, and granulomatosis with polyangiitis.

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Inflammation Is Associated with Voriconazole Trough Concentrations
Marjolijn J. P. van Wanrooy, Lambert F. R. Span, Michael G. G. Rodgers, Edwin R. van den Heuvel, Donald R. A. Uges, Tjip S. van der Werf, Jos G. W. Kosterink, Jan-Willem C. Alffenaar
Antimicrobial Agents and Chemotherapy Nov 2014, 58 (12) 7098-7101; DOI: 10.1128/AAC.03820-14

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Inflammation Is Associated with Voriconazole Trough Concentrations
Marjolijn J. P. van Wanrooy, Lambert F. R. Span, Michael G. G. Rodgers, Edwin R. van den Heuvel, Donald R. A. Uges, Tjip S. van der Werf, Jos G. W. Kosterink, Jan-Willem C. Alffenaar
Antimicrobial Agents and Chemotherapy Nov 2014, 58 (12) 7098-7101; DOI: 10.1128/AAC.03820-14
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