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. 2025 Dec;22(6):411-420.
doi: 10.1080/17410541.2025.2592525. Epub 2025 Dec 2.

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

Mai Samy Azab  1   2 , Dalia Makhlouf  1   3 , Omneya Ahmed  1   4 , Omneya Hassanain  5 , Lobna Shalaby  4   6 , Mohamed Nagy  1   3
Affiliations

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

Mai Samy Azab et al. Per Med. 2025 Dec.

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.

Keywords: Voriconazole; infectious diseases pharmacist; pediatric oncology; personalized medicine; therapeutic drug monitoring.

Plain language summary

This paper investigates how Infectious Disease (ID) pharmacists enhance voriconazole (VCZ) treatment for pediatric oncology patients. VCZ dosing is complex, requiring therapeutic drug monitoring (TDM) to ensure efficacy and safety. The study compared VCZ dose individualization before and after ID pharmacy service implementation. Findings revealed a significant increase in adherence to TDM recommendations, rising from 89% to 95% post-implementation. Doctor acceptance of ID pharmacist interventions was also high (95%), and TDM test orders doubled. This demonstrates that ID pharmacists play a crucial role in optimizing VCZ therapy, leading to improved, personalized care and better outcomes for children fighting fungal infections.

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