Switching antifungals drugs within the triazole drug class: a potential
treatment approach to drug-related hepatotoxicity
Abstract
There are limited data on the best approach to managing azole-induced
hepatotoxicity. One described approach is switching between different
triazole agents to prevent the need for intravenous therapy. This case
series describes the outcomes of this approach in seven children. The
most common azole switch was voriconazole to fluconazole (3/7), followed
by fluconazole to voriconazole (2/7). One child each switched from
voriconazole to itraconazole, and posaconazole to fluconazole. Of the
seven cases, five had Grade 3 liver injury and two had Grade 2 liver
injury. These LFT abnormalities were deemed as ‘possibly’ in four cases,
and ‘probably’ in three cases to be related to the first azole
antifungal as per the Naranjo criteria. All had improvement in their LFT
abnormalities after the switch to an alternative azole antifungal. These
data suggest that switching azole antifungals offers a potential
treatment approach to azole-induced hepatotoxicity.