Voriconazole TDM — SCE Infectious Diseases MCQ

Correct answer: C — Review adherence and interactions, increase the dose under specialist supervision, and repeat a trough after reaching the new steady state after susceptibility review

The best answer is “Review adherence and interactions, increase the dose under specialist supervision, and repeat a trough after reaching the new steady state after susceptibility review”. The measured exposure is below the usual efficacy threshold; correcting adherence, interactions and dose is necessary before declaring class failure. “Switch immediately without investigating subtherapeutic exposure” is less appropriate because it conflicts with the clinical discriminator or cited guidance. “Add flucytosine because it reliably treats Aspergillus” is less appropriate because it conflicts with the clinical discriminator or cited guidance. “Use an echinocandin alone without reassessing diagnosis or susceptibility” is less appropriate because it conflicts with the clinical discriminator or cited guidance. “Continue the same dose despite progressive disease” is less appropriate because it conflicts with the clinical discriminator or cited guidance.

Reference: British Society for Medical Mycology antifungal TDM guideline: https://academic.oup.com/jac/article/69/5/1162/680284