• Victor Kaneko Matsuno, CamposEdvaldo Vieira deEVFaculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, SP, Brazil., Elson Mendes da Silva Junior, Silva JuniorJoão Manoel daJMDFaculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, SP, Brazil., David de Souza Gomez, and SantosSilvia Regina Cavani JorgeSRCJFaculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, SP, Brazil..
• Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, SP, Brazil. Electronic address: victor.matsuno@usp.br.
• Clinics (Sao Paulo). 2024 Jan 1; 79: 100491100491.

ObjectivesThe Fluconazole pharmacokinetic-pharmacodynamic relationship was investigated in a few clinical settings and only limited studies regarding burned patients are available. Thus, the authors aimed to investigate fluconazole pharmacokinetics changes and its impact on antifungal therapy coverage against dose-dependent Candida spp. applying the PK/PD approach in critically ill severely burned patients.MethodsFluconazole was administered as a one-hour intravenous infusion of 200 mg q12h. Doses were increased according to the coverage based on the PK/PD approach. Blood samples were collected at the end of the infusion (1st hour), two hours after (3rd hour), and before the next dose (12th or 24th hour). Serum concentrations were obtained by HPLC-UV. Pharmacokinetic parameters were estimated by noncompartmental analysis and compared with data described in healthy subjects. The effectiveness predictive index was based on the AUCss0-24h/MIC ratio, with a target above 25.ResultsEvery pharmacokinetic parameter was reduced throughout all three sets of the study. Compared to healthy subjects, the volume of distribution was decreased about 3‒7 times, biological half-life was 2‒3 times shorter and total body clearance was slightly altered but statistically significant. Both half-life and total body clearance were correlated to the volume of distribution. Consequently, an increase in fluconazole daily dose was necessary to improve empiric coverage.ConclusionsFluconazole pharmacokinetics is altered in critically ill severely burned patients, mainly related to the volume of distribution. Doses higher than usual may be necessary to reach the PK/PD target and guarantee antifungal coverage against dose-dependent Candida spp. up to MIC 32 mg/L.Copyright © 2024 HCFMUSP. Published by Elsevier España, S.L.U. All rights reserved.

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