Evaluating the impact of infectious disease pharmacy services on voriconazole dose individualization in pediatric oncology

Abstract

Background The application of personalized medication management for Voriconazole(VCZ), such as therapeutic drug monitoring (TDM), is the gold standard for attaining therapeutic goals in invasive fungal infections. Infectious disease (ID) pharmacists are the best for ensuring the recommendations are properly implemented.Aim To assess the adherence of healthcare teams to VCZ dose individualization and the impact of the ID pharmacy team.Method This study included pediatric oncology patients who received VCZ in the inpatient department and had VCZ TDM level measurements for 3 months (from January to March 2019) and after implementing the (ID) pharmacy service during the same months in two different years (2020, 2021).Results This study included 989 patients who received VCZ; only 588/989 patients (59.5%) had VCZ TDM levels. Dose individualization was required for 62.6% (849/1357) levels, while 37.4% (508/1357) levels were in the therapeutic range. The overall compliance rate with the TDM recommendations was 92.9% (789/849). Additionally, there was a significant increase in VCZ dose individualization adherence after ID pharmacy implementation (88.6% (210/237) vs. 94.6% (579/612), p = 0.002). The rate of doctor acceptance of the ID pharmacist intervention was 94.7%.Conclusion ID pharmacists’ contributions are crucial and can increase clinicians’ adherence to individualized dose recommendations.