Factors affecting voriconazole pharmacokinetic variability in critically ill patients: a systematic review

A systematic dose adaptation is required for patients with liver dysfunction, and voriconazole dose calculation should not be based on total body weight, with an adjusted body weight a preferred alternative. Intravenous administration should be favoured in patients without severe renal dysfunction. Further research to define the benefit of an individualised dosing approach for voriconazole in ICU patients that combines pharmacokinetic modelling and machine learning, is warranted. Meanwhile, close therapeutic drug monitoring is needed for ICU patients, especially those with identified risk factors for under- or overexposure.