From the Research
Voriconazole is a suitable treatment option for Exophiala infections, with a MIC90 of 1 μg/ml, as reported in the most recent study 1. The typical adult dosing regimen for voriconazole begins with a loading dose of 6 mg/kg IV every 12 hours for the first day, followed by a maintenance dose of 4 mg/kg IV every 12 hours. For oral therapy, use 200-300 mg twice daily. Some key points to consider when using voriconazole for Exophiala infections include:
- Treatment duration is generally prolonged, typically ranging from 3-6 months depending on infection severity, site, and clinical response.
- Therapeutic drug monitoring is recommended to maintain trough levels between 1-5.5 mg/L to ensure efficacy while minimizing toxicity.
- Common side effects include visual disturbances, hepatotoxicity, and photosensitivity reactions.
- Regular liver function tests and ophthalmologic examinations are advised during treatment.
- Voriconazole is effective against Exophiala because it inhibits fungal cytochrome P450-dependent 14α-lanosterol demethylation, disrupting ergosterol synthesis in the fungal cell membrane.
- For severe or refractory cases, combination therapy with an echinocandin or surgical debridement may be necessary.
- Patients should avoid sun exposure during treatment and take the medication either one hour before or after meals for optimal absorption. It's worth noting that while other studies have reported the efficacy of voriconazole against Exophiala species 2, 3, 4, 5, the most recent study 1 provides the most up-to-date information on the antifungal susceptibility of Exophiala isolates.