Abstract
Voriconazole is the primary treatment for invasive pulmonary
aspergillosis (IPA) and it has been used to treat patients colonized by
Aspergillus spp. The pulmonary route could increase drug concentration
in the biophase, reduce drug-drug interactions (DDI) and minimize
adverse events (AE); however, there is scarce evidence about its use and
there are no commercial voriconazole formulations for nebulization. The
goal of this study is to characterize the compounded voriconazole
solution for nebulization and describe its use in our center. This is a
retrospective observational study including all patients treated with
nebulized voriconazole to treat pulmonary fungal infections or
colonizations. Voriconazole solution was prepared from commercial vials
for intravenous administration. The pH and osmolarity of voriconazole
solutions were adequate for nebulization, the dosage was 40 mg in adults
and 10mg in the paediatric patient, administered every 12-24h. The
median duration of treatment was 139 (26-911) days, there were no
reported adverse effects related to voriconazole nebulization and the
drug was not detected in plasma when used through the pulmonary route
only. There were 3 cases of death, one case of voriconazole resistance,
3 cases of microbiological response, 2 cases of colonization without
exacerbation and one case of successful prophylaxis. Voriconazole
nebulization is well-tolerated and the drug is not absorbed into the
systemic circulation. Further research is needed to assess voriconazole
nebulization efficacy in specific clinical situations.