JAC Advance Access originally published online on March 23, 2006
Journal of Antimicrobial Chemotherapy 2006 57(6):1248-1250; doi:10.1093/jac/dkl108
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Incidence of voriconazole hepatotoxicity during intravenous and oral treatment for invasive fungal infections
1 Department of Internal Medicine, MCRZ Rotterdam, The Netherlands 2 Department of Internal Medicine, Section of Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, The Netherlands 3 Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, The Netherlands 4 Department of Hematology, Erasmus MC, University Medical Center Rotterdam, The Netherlands 5 Department of Medical Oncology, Erasmus MC, University Medical Center Rotterdam, The Netherlands 6 Department of Internal Medicine, Albert Schweitzer Hospital Dordrecht, The Netherlands
Received 6 January 2006; returned 5 February 2006; revised 3 March 2006; accepted 7 March 2006
*Correspondence address. Department of Internal Medicine, Section of Infectious Diseases, Erasmus University Medical Center, Room D418, PB2040 3000 CA Rotterdam, The Netherlands. Tel: +31-010-4639222; Fax: +31-010-4635945; E-mail: b.rijnders{at}erasmusmc.nl
Objectives: Absorption of oral voriconazole is good and in contrast to the intravenous (iv) formulation it can be given in patients with renal insufficiency. Furthermore, the acquisition costs are significantly lower. The aim of this study was to compare the incidence of hepatotoxicity in patients treated with the oral formulation of voriconazole with that in patients treated with the iv formulation.
Methods: This was a retrospective observational study. A total of 35 patients with haematological disease and an invasive fungal infection were treated with oral voriconazole during the entire regimen. We compared the incidence of hepatotoxicity with that in 11 patients treated intravenously during the first week.
Results: The incidence of increased liver enzymes was comparable between both groups. Voriconazole was discontinued in two patients in the oral group and one patient in the iv group because of hepatotoxicity. The incidence of liver enzyme elevations in the entire study cohort of 46 patients was higher than that previously reported in a comparable study population (P < 0.001). However, clinically significant hepatotoxicity was infrequently observed (3/46 or 6.5%).
Conclusions: In 35 patients with invasive fungal infections we instituted oral voriconazole therapy from day 1 and found an incidence of hepatotoxicity comparable to 11 controls treated intravenously.
Keywords: therapy , invasive aspergillosis , haematological disease
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