CASE REPORT article
Front. Med.
Sec. Pulmonary Medicine
Therapeutic Drug Monitoring-guided Optimization of Isavuconazole Dose for ICU Patients with Refractory Pulmonary Aspergillosis: A Case Report
Mingyue Yang 1,2
Xiaoshuang He 1
Qiuya Lu 3
Xiaolan Bian 1
Jie Fang 1
Yongjie Ding 4,5,6
1. Department of Pharmacy, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, shanghai, China
2. Department of Pharmacy, Yantai Yuhuangding Hospital, shandong, China
3. Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, shanghai, China
4. Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
5. Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, shanghai, China
6. Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, shanghai, China
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Abstract
Isavuconazole (ISA) is recommended as first-line therapy for pulmonary aspergillosis. In ICU patients, isavuconazole (ISA) exhibits enhanced clearance, greater volume of distribution, but lower plasma concentrations, indicating requirements for plausible dose adjustment. However, current evidence regarding off-label ISA dosing regimens for ICU patients is restricted to pharmacokinetic prediction modeling, with no published clinical studies available to date. In this case, a prolonged ISA-loading dosing regimen was applied to address prior standard ISA treatment failures, thereby pharmacokinetic steady-state was achieved with serial therapeutic drug monitoring (TDM)-guided dose optimization. This study illustrated a favorable clinical course associated with TDM-guided dosing adjustment with no severe adverse reactions. Given the limited sample size, it is critical to investigate the clinical scenario to adequately provide reference for ISA dosing guidelines and TDM strategies for ICU practice.
Summary
Keywords
Intensivecare unit, Isavuconazole, pharmacokinetics, Pulmonary Aspergillosis, Therapeutic drug monitoring
Received
27 August 2025
Accepted
20 February 2026
Copyright
© 2026 Yang, He, Lu, Bian, Fang and Ding. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Jie Fang; Yongjie Ding
Disclaimer
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