Nebulized voriconazole treatment
Nebulized voriconazole treatment was mainly initiated in the hospital wards (5; 50%), but it also started in the intensive care unit (3; 30%) or outpatient (2; 20%). The main reasons for treatment initiation were lack of response to antifungals (4; 40%) and systemic treatment toxicity (4; 40%); other reported reasons were avoiding clinically relevant DDI (2;20%), post LT prophylaxis (1;10%) and booster oral voriconazole effect (1; 10%).
The voriconazole dose used was 40 mg in adults and 10mg in the paediatric patient. It was administered using jet nebulizers every 12 or 24 hours, only patients with CF and fungal colonization receiving outpatient treatment used lower frequencies (table 2). Nebulized voriconazole was used as monotherapy in 2 cases (2; 20%), it was combined with systemic therapy in 7 cases (7; 70%) and used in combination with nebulized mycafungin in 1 case (1; 10%). The median duration of treatment was 139 (26-911) days; short treatments correspond to patients who died, whereas long treatments were used in colonized patients.