Therapeutic drug monitoring of voriconazole helps to decrease the percentage of patients with off-target trough serum levels.

We monitored trough voriconazole serum concentrations from 107 patients (n = 258 samples) at 6 hospitals in Madrid. Most of the patients were male (67%) and had the following underlying conditions: hematological cancer (42%), solid organ transplantation (15%), chronic obstructive pulmonary disease (14%), human immunodeficiency virus infection (8.4%), solid cancer (5.6%), and other (29%). The indication for voriconazole administration was aspergillosis treatment (74.6%) and prophylaxis (14%). The main reasons for voriconazole trough drug monitoring were initiation of treatment/prophylaxis (33%), patient monitoring (47%), and suspected toxicity (3.5%). Levels (µg/ml) were subtherapeutic (<1; 18.2%), on-target (1-5.5; 71.3%), and high (>5.5; 10.5%). The samples percentage with on-target levels was significantly lower for the first sample than for subsequent samples (62.6% vs. 77.5%). "Subsequent samples," "admission in nonpediatric wards," "voriconazole used for treatment of invasive aspergillosis," and "use of proton pump inhibitors" were predictors of voriconazole therapeutic levels (≥1 µg/ml).

Bezlotoxumab in the treatment of Clostridioides difficile infections: a real-life experience / Bezlotoxumab para el tratamiento de las infecciones por Clostridioides difficile:experiencia en vida real

Background. Following the approval of bezlotoxumabin 2017, studies evaluating its effectiveness in prevention ofClostridioides difficile infection under “real-life” conditions arescarce.Material and methods. We conducted a retrospectivestudy developed in a large tertiary care hospital describing theuse and outcomes of patients with Clostridioides difficile infection (CDI) treated with bezlotoxumab.Results. A total of 16 patients were include, all of whomhad an episode of CDI with high probability of recurrence and14 of them had some kind of immunosuppression. Bezlotoxumab was effective in the prevention of CDI recurrence in 11of the 14 cases in which follow up was possible, without significant side effects.Conclusions. Bezlotoxumab was well tolerated and theincidence of recurrent CDI in a high-risk population for recurrence was only 21.4%. (AU)

Antecedentes. Tras la aprobación de bezlotoxumab en2017, son escasos los estudios que evalúan su eficacia en laprevención de la infección por Clostridioides difficile en condiciones de vida real. Material y métodos. Realizamos un estudio retrospectivo desarrollado en un hospital terciario describiendo el uso ylos resultados de los pacientes con infección por Clostridioidesdifficile (ICD) tratados con bezlotoxumab.Resultados. Se incluyeron un total de 16 pacientes, todosellos con un episodio de ICD con alto riesgo de recurrencia y14 de ellos con algún tipo de inmunosupresión. El bezlotoxumab fue eficaz en la prevención de la recurrencia de la ICD en11 de los 14 casos en los que fue posible el seguimiento, sinefectos secundarios significativos.Conclusiones. El bezlotoxumab fue bien tolerado. La incidencia de ICD recurrente en una población de alto riesgo derecurrencia, fue sólo del 21,4%. (AU)