ArticleAntimicrobial agents and chemotherapy2014
A reference laboratory experience of clinically achievable voriconazole, posaconazole, and itraconazole concentrations within the bloodstream and cerebral spinal fluid.
Article in Antimicrobial agents and chemotherapy, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers.
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Who cites it
31 citing papers in PubMed, 73 citations in OpenAlex.
- Isavuconazole Treatment of Cryptococcosis and Dimorphic Mycoses.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2016Trial
- Pharmacokinetics of posaconazole prophylaxis of patients with acute myeloid leukemia.Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy · 2015Trial
- Multisystemic paracoccidioidomycosis with rare retinal and central nervous system involvement: a case report.Medical mycology case reports · 2026Article
- MSG-15: Super-Bioavailability Itraconazole Versus Conventional Itraconazole in the Treatment of Endemic Mycoses-A Multicenter, Open-Label, Randomized Comparative Trial.Open forum infectious diseases · 2024Article
- High-Risk Neutropenic Fever and Invasive Fungal Diseases in Patients with Hematological Malignancies.Microorganisms · 2024Review
- Modeling and Simulation as a Tool to Assess Voriconazole Exposure in the Central Nervous System.Pharmaceutics · 2023Article
- Pharmacokinetic and clinical comparison of super-bioavailable itraconazole and conventional itraconazole at different dosing in dermatophytosis.Drugs in context · 2023Article
- [Clinical Analysis of Voriconazole Concentrations in Cerebrospinal Fluid and Blood in Patients with Ryptococcal Meningitis].Sichuan da xue xue bao. Yi xue ban = Journal of Sichuan University. Medical science edition · 2023Article
- Meningeal Sporotrichosis Due toJournal of fungi (Basel, Switzerland) · 2022Article
- Effects of Itraconazole and Micafungin on Aspergillus fumigatus Biofilms.Mycopathologia · 2021Article
- Variability of Hydroxy-Itraconazole in Relation to Itraconazole Bloodstream Concentrations.Antimicrobial agents and chemotherapy · 2021Article
- Voriconazole as a secondary prophylaxis for cryptococcal meningitis during hematopoietic stem cell transplantation.IDCases · 2021Article
- Concentration-dependent Early Antivascular and Antitumor Effects of Itraconazole in Non-Small Cell Lung Cancer.Clinical cancer research : an official journal of the American Association for Cancer Research · 2020Article
- Open-Label Crossover Oral Bioequivalence Pharmacokinetics Comparison for a 3-Day Loading Dose Regimen and 15-Day Steady-State Administration of SUBA-Itraconazole and Conventional Itraconazole Capsules in Healthy Adults.Antimicrobial agents and chemotherapy · 2020Article
- Antifungal Triazole Posaconazole Targets an Early Stage of the Parechovirus A3 Life Cycle.Antimicrobial agents and chemotherapy · 2020Article
- Trichophyton rubrum Azole Resistance Mediated by a New ABC Transporter, TruMDR3.Antimicrobial agents and chemotherapy · 2019Article
- Impact of Triazole Therapeutic Drug Monitoring Availability and Timing.Antimicrobial agents and chemotherapy · 2019Article
- Article
- Isavuconazole Concentration in Real-World Practice: Consistency with Results from Clinical Trials.Antimicrobial agents and chemotherapy · 2018Article
- The Novel Fungal Cyp51 Inhibitor VT-1598 Is Efficacious in Experimental Models of Central Nervous System Coccidioidomycosis Caused by Coccidioides posadasii and Coccidioides immitis.Antimicrobial agents and chemotherapy · 2018Article
Corrections and comments
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Authors and funding
8 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Interest in antifungal therapeutic-drug monitoring has increased due to studies demonstrating associations between concentrations and outcomes. We reviewed the antifungal drug concentration database at our institution to gain a better understanding of achievable triazole drug levels. Antifungal concentrations were measured by high-performance liquid chromatography (HPLC), ultraperformance liquid chromatography and single-quadrupole mass spectrometry (UPLC/MS), or a bioassay. For this study, only confirmed human bloodstream (serum or plasma) and cerebral spinal fluid (CSF) concentrations of voriconazole, posaconazole, and itraconazole were analyzed. The largest numbers of bloodstream and CSF samples were found for voriconazole (14,370 and 173, respectively). Voriconazole bloodstream concentrations within the range of 1 to 5.5 μg/ml represented 50.6% of samples. Levels below the lower limit of quantification (0.2 μg/ml) were observed in 14.6% of samples, and 10.4% of samples had levels of ≥5.5 μg/ml. CSF voriconazole levels ranged from undetectable to 15.3 μg/ml and were <0.2 μg/ml in 11% of samples. Posaconazole bloodstream concentrations were ≥0.7 and ≥1.25 μg/ml in 41.6% and 18.9% of samples, respectively. Posaconazole was detected in only 4 of 22 CSF samples (undetectable to 0.56 μg/ml). Itraconazole levels, as measured by UPLC/MS, were ≥0.5 μg/ml in 43.3% and were undetectable in 33.9% of bloodstream samples. In contrast, when measured by a bioassay, itraconazole/hydroxyitraconazole bloodstream concentrations were ≥1.0 μg/ml in 72.9% of samples and were undetectable in 18% of samples. These results indicate that there is marked variability in bloodstream concentrations achieved with these three azoles. In addition, many levels within the bloodstream for each azole and for voriconazole and posaconazole in the CSF were undetectable or below thresholds associated with efficacy.
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