Plasma levels of voriconazole administered via a nasogastric tube to critically ill patients

Excerpt

Rates of invasive fungal infection have dramatically increased over the past 2 decades, probably because advances in medical technology have increased the survival of patients with complex diseases and immunodeficiencies [1]. While the morbidity and mortality associated with these infections is substantial, amphotericin B has long been the only treatment option. The introduction of fluconazole in the 1980s constituted a major advance in the systemic treatment of invasive candidiasis. However, worries concerning increased resistance, due either to the emergence of resistance in previously susceptible species or the emergence of species with primary resistance to fluconazole, coupled with the drug’s limited activity against Aspergillus spp., has resulted in the continued search for new antifungal agents. Voriconazole is a new triazole with a broad spectrum of activity against clinically important pathogens such as Candida, Aspergillus, Cryptococcus neoformans, and against emerging and less common pathogens including Scedosporium or Fusarium spp. [2]. It is now approved for the primary treatment of aspergillosis, for salvage therapy in cases of serious infections caused by unusual moulds, and for the treatment of fluconazole-resistant Candida infections. …