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Voriconazole salvage treatment of invasive candidiasis.

Abstract
Data on the salvage treatment of invasive candidiasis with voriconazole in 52 patients intolerant of other antifungal agents or with infection refractory to other antifungal agents were analyzed. Patients had received a mean of two previous antifungal agents (range, 1-4 agents), and 83% had received an azole. Manifestations of invasive candidiasis included candidemia (37%), disseminated disease (25%), and infection of other sites (38%). The median duration of voriconazole therapy was 60 days (range, 1-314 days). The overall rate of response was 56% (95%CI, 41-70), with the following response rates observed for individual Candida species: Candida albicans, 44% (20-70); Candida glabrata, 38% (14-68); Candida krusei, 70% (35-93); Candida tropicalis, 67% (30-93); and other Candida spp., 100% (40-100). The response rate in patients who had failed previous azole therapy was 58% (42-73). Common adverse events (~20%) included nausea and emesis, abnormal liver enzymes, and visual disturbances. Serious adverse events occurred in four patients, and nine patients died. Voriconazole has promise as a salvage agent for the treatment of invasive candidiasis, even in the settings of previous azole therapy and infection due to Candida krusei.
AuthorsL Ostrosky-Zeichner, A M L Oude Lashof, B J Kullberg, J H Rex
JournalEuropean journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology (Eur J Clin Microbiol Infect Dis) Vol. 22 Issue 11 Pg. 651-5 (Nov 2003) ISSN: 0934-9723 [Print] Germany
PMID14564539 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
Chemical References
  • Antifungal Agents
  • Pyrimidines
  • Triazoles
  • Voriconazole
Topics
  • Adolescent
  • Adult
  • Aged
  • Antifungal Agents (administration & dosage)
  • Candida (classification)
  • Candidiasis (diagnosis, drug therapy)
  • Child
  • Child, Preschool
  • Cohort Studies
  • Confidence Intervals
  • Dose-Response Relationship, Drug
  • Drug Administration Schedule
  • Female
  • Follow-Up Studies
  • Fungemia (diagnosis, drug therapy)
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Pyrimidines (administration & dosage)
  • Risk Assessment
  • Salvage Therapy
  • Severity of Illness Index
  • Treatment Outcome
  • Triazoles (administration & dosage)
  • Voriconazole

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