Clinical Application Of Voriconazole In Prophylaxis And Treatment Of Invasive Fungal Disease And The Application Of Therapeutic Drug Monitoring

Objective To investigate the clinical application of voriconazole in prophylaxis and treatment of hospital invasive fungal infection and evaluate the efficacy and safety of voriconazole,analysis of the rationality;To analysis of voriconazole plasma drug concentration,find the possible influence factor and the relationship between drug adverse reactions and plasma drug concentration.Methods Retrospective analysis was used to investigate the hospitalized patients used voriconazole in HIS and EMR system from January 1,2016 to December 31 st,fill out the questionnaire,pool voriconazole clinical application by Microsoft Excel2010.To evaluate the clinical efficacy and adverse drug reactions of voriconazole according to established standards.To evaluate the rationality of voriconazole according to established standards.Determination of plasma drug concentration were used by HPLC.To keep an account of patients information and analysis of influence factors of voriconazole plasma drug concentration and the relationship between drug adverse reactions and plasma drug concentration.Results: A total of 425 patients was found.The average age of the patients was 58 years old,65.4% was male.The length of stay was 27.80 days.Voriconazole was most widely used in Department of respiration and Department of Hematology,with the basis disease of hematological malignancies,malignant tumor and diabetes.Empirical treatment was accounted for 59.53%,with the most common infection site lung and prophylactic use was accounted for 28%.The source of the pathogenic microorganisms was sputum(50.82%),and the pathogenic bacteria were mainly Candida albicans.94.82% of the patients were treated antibiotics in company with voriconazole.The two compounds used widely was Glycopeptides.The clinical effective rate was 66.67%(204 cases).The clinical effective rate was higher with the patients of the clinical diagnosis than others,but the difference was not statistically significant(P=0.062).The incidence rate of adverse reaction was 12%.There were 70.59% males.The average age is 63.75 and the main route of administration by intravenous voriconazole(84.31%),ADR is the most frequently involved nervous system and the clinical symptom mostly was hallucinations and erethitic.The clinical symptom were improved when stopping drug.340 patients was of irrational use,which is the most common form of unreasonable dosage unreasonable.52 voriconazole plasma drug concentrations of 43 patients was found.The average age of patients was 53.43.The weight average value is58.0kg.There was no relationship between the patient's age,weight,gender,ALT,AST,Cr or Cr Cl and voriconazole plasma drug concentration.TBIL was associated with voriconazole plasma drug concentration(P=0.036).The huge individual difference was found in voriconazole plasma drug concentration from 0.14ug/ml to24.63ug/ml.Voriconazole plasma drug concentration in the safe and effective range(1-5.5 ug/ml)ratio was 53.85%,and 28.85% patients failed to reach the effective concentration range of voriconazole.The incidence of ADR was significantly higher when plasma drug concentration >5.5ug/ml than other groups.Conclusion The clinical effective rate of voriconazole in the treatment of invasive fungal disease was good and adverse drug reaction is common,but were relatively mild.The irrational use of voriconazole is serious.The huge individual difference was found in voriconazole plasma drug concentration.Therapeutic Drug Monitoring of voriconazole should be recommended...