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Switching antifungals drugs within the triazole drug class: a potential treatment approach to drug-related hepatotoxicity
  • Eloise Silvester,
  • Christine Plover,
  • Amanda Gwee
Eloise Silvester
The Royal Children's Hospital Melbourne
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Christine Plover
The Royal Children's Hospital Melbourne
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Amanda Gwee
The Royal Children's Hospital Melbourne

Corresponding Author:amanda.gwee@rch.org.au

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There are limited data on the best approach to managing azole-induced hepatotoxicity. One described approach is switching between different triazole agents to prevent the need for intravenous therapy. This case series describes the outcomes of this approach in seven children. The most common azole switch was voriconazole to fluconazole (3/7), followed by fluconazole to voriconazole (2/7). One child each switched from voriconazole to itraconazole, and posaconazole to fluconazole. Of the seven cases, five had Grade 3 liver injury and two had Grade 2 liver injury. These LFT abnormalities were deemed as ‘possibly’ in four cases, and ‘probably’ in three cases to be related to the first azole antifungal as per the Naranjo criteria. All had improvement in their LFT abnormalities after the switch to an alternative azole antifungal. These data suggest that switching azole antifungals offers a potential treatment approach to azole-induced hepatotoxicity.
11 Jan 2023Submitted to British Journal of Clinical Pharmacology
12 Jan 2023Assigned to Editor
12 Jan 2023Submission Checks Completed
12 Jan 2023Review(s) Completed, Editorial Evaluation Pending
07 Feb 2023Reviewer(s) Assigned