Photo Credit: Freepick

The following is a summary of “Higher doses of fluconazole are needed to ensure target attainment in critically ill adults on continuous Veno-venous hemodialysis,” published in the February 2025 issue of Journal of Critical Care by Coenradie et al. 

Higher fluconazole doses were recommended for individuals with critical illness on Continuous Renal Replacement Therapy (CRRT), but data on the effectiveness were limited.  

Researchers conducted a retrospective study to determine whether higher fluconazole doses achieved target attainment and to identify factors contributing to variability in fluconazole exposure.  

They analyzed data from the tertiary intensive care unit of Erasmus MC University Medical Center in Rotterdam, Netherlands, from July 2017 to March 2023. Ethical approval was obtained from the Medical Research Ethics Committee of Erasmus MC (MEC 2022–0435). Patients with critical illness undergoing Continuous Veno-Venous Hemodialysis (CVVHD) who received either standard or higher intravenous fluconazole doses were included. Target attainment was assessed for each dosing regimen.  

The results showed that administering at least 400 mg of fluconazole twice daily achieved 100% target attainment. Fluconazole dose was the only significant factor affecting target attainment (P < 0.001), with no other predefined factors showing a significant impact. Among 40 individuals undergoing CRRT with fluconazole trough levels, 27 were included in the analysis, while 10 were excluded due to non-compliance with inclusion criteria for fluconazole trough levels, and 3 due to incomplete CVVHD data. Median age was 54.0 years [42.0–65.0].   

Investigators concluded that increasing the fluconazole dose to at least 400 mg twice daily was sufficient to reach the desired target in patients with critical illness undergoing CVVHD. 

Source: sciencedirect.com/science/article/abs/pii/S0883944124004118