Evaluation of Voriconazole and Posaconazole Dosing in Patients With Thermal Burn Injuries.

Fungal infections are a recognized cause of increased morbidity and mortality in thermal burn patients. Adequate treatment regimens remain a challenge due to unpredictable pharmacokinetic/pharmacodynamic changes caused by a hypermetabolic state and individual patient factors. A retrospective evaluation of adult thermal burn patients from April 2014 to April 2020 was conducted to assess voriconazole and posaconazole antifungal dosing regimens. The primary outcome was the incidence of attaining a therapeutic steady-state trough level on the patient's initial voriconazole or posaconazole regimen. Of the 33 patients analyzed, 26 (78.8%) patients achieved a therapeutic level during azole therapy. However, only 11 (33.3%) patients achieved a therapeutic level on their first azole regimen. The median time to therapeutic level was 8.0 + 21.8 days from the start of azole therapy. Optimal dosing strategies for azole therapy in patients with thermal burns remain undefined. Further assessment is needed to delineate patient-specific factors that can contribute to subtherapeutic azole levels in thermal burn patients and the overall clinical impact of population-specific dosing regimens.