Voriconazole

Abstract

Voriconazole appears to be a useful alternative to conventional antifungal agents in cases of resistance or intolerance to initial therapy. However, dose adjustment is recommended in patients with hepatic dysfunction, as well as in those receiving medications that may interact with voriconazole via hepatic metabolism.

Fusarium dimerum infection in a stem cell transplant recipient treated successfully with voriconazole

“…However, voriconazole is increasingly being used to treat infections unresponsive to the more conventional antifungals and is reported in the literature to be effective both in vitro and in vivo against these resistant moulds. [3][4][5][6] Case report…”

Oral voriconazole for invasive fungal skull base infection

“…11 As a second generation triazole highly active against the enzyme cytochrome P450 14a-demethylase, voriconazole inhibits ergosterol in the cell membrane, disrupting fungal growth. 1 In a study by Baden et al, predominantly of immunocompromised patients failing or intolerant of standard antifungal therapy, seven of eight patients with central nervous system or sinus disease had a good response to voriconazole. 12 This is compared to a previously reported, overall treatment response rate of 37 per cent for treatment of aspergillus species infections at various sites.…”

“…13 The known ability of voriconazole to penetrate bone was an additional theoretical advantage; two diabetic but otherwise immunocompetent patients with skull base fungal bone invasion have been reported to have died of neurological sequelae. 1,5 . Intravenous (IV) amphotericin or voriconazole, with a subsequent IV to oral switch, has been used to treat invasive sinus aspergillosis with extension into the skull base .…”

“…This is unsurprising, as voriconazole has 96 per cent oral bioavailability. 1 The use of an oral regimen throughout the treatment course is noteworthy, as oral administration has considerable logistical and financial advantages, is safer, is preferred by patients, and facilitates early discharge from hospital. Since 2006 in the UK, oral voriconazole has cost £79 per daily dose (the cost is doubled on the first day).…”

“…Voriconazole is a second generation triazole antifungal agent which is known to penetrate bone, and which has been used successfully in invasive aspergillosis. 1,2 Here, we present the case of a patient with biopsyproven, invasive aspergillosis involving the skull base and orbit, which responded dramatically to exclusively oral voriconazole therapy.…”