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.