Therapeutic Drug Monitoring of Voriconazole in Non-Elderly and Elderly Patients: A prospective Observational Study

Background Therapeutic drug monitoring (TDM) of voriconazole (VCZ) was strongly recommended due to the highly variable drug exposure. The VCZ serum trough concentration (VCZ- C _min ) was affected by multiple factors, which made dosage adjustments more challenging. However, there is a paucity of data regarding the variability of VCZ- C _min in critically ill elderly patients. Method A prospective observational study was conducted at Zhengzhou Central Hospital Affiliated to Zhengzhou University, which included 427 elderly patients (aged 60 years and above) and 114 non-elderly patients (aged 18–60 years). The initial VCZ- C _min , correlation of various factors, and risk prediction factors for VCZ- C _min and hepatotoxicity were compared between elderly and non-elderly patients. Results The C _min was significantly higher in the elderly group in comparison with the non-elderly group (p < 0.01).Total bilirubin (TBIL), the daily voriconazole (VCZ) dose, C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), and albumin were correlated with VCZ- C _min in the elderly group (all p < 0.05). IL-6, the average daily dose, PCT, albumin, VCZ route of administration, and CRP were significant factors influencing VCZ- C _min in elderly patients (p < 0.05). VCZ- C _min , albumin, AST, and TBIL exerted a significant effect on hepatotoxicity in elderly patients. Conclusions A VCZ individualised dosage in elderly patients should be based on these specific factors before VCZ administration. Furthermore, TDM after starting treatment should be monitored early to avoid hepatotoxicity.