Voriconazole (Vfend), as a broad-spectrum triazole antifungal drug, has significant therapeutic effects on pathogens such as Aspergillus and Candida, but the course of treatment needs to be adjusted according to the type of infection and patient response. Discontinuation of medication should be gradually reduced and signs of recurrence monitored. Special populations should pay attention to liver function and drug interactions.

1. Evaluation of treatment efficacy

(1) Invasive aspergillosis

The effective rate of first-line treatment is about 53%, and the survival rate is 20% higher than that of traditional amphotericin B. After 6-12 weeks of treatment, the efficacy needs to be evaluated through imaging and microbiology.

(2) Candidemia

The clearance rate of fluconazole resistant strains reaches 75%, and medication needs to be continued until 14 days after the blood culture turns negative. The clinical remission rate of esophageal candidiasis exceeds 80%.

(3) Other fungal infections

The effective rate for rare infections such as Fusarium and Clostridium perfringens is 40-60%, and comprehensive treatment such as surgical debridement is required.

2. Precautions for discontinuation of medication

(1) Standard discontinuation process

After completing the prescribed course of treatment, individuals with normal immune function can directly discontinue medication; Immunosuppressed patients need to gradually reduce their dosage for 1-2 weeks after immune function recovery.

(2) Relapse monitoring

Within 3 months after discontinuing the medication, conduct monthly follow-up G/GM tests. If any suspicious symptoms such as fever occur, immediately re evaluate. HIV patients need lifelong secondary prevention.

(3) Handling of liver function abnormalities

When ALT/AST levels increase by more than 5 times during treatment, the medication should be stopped and restarted at half the dose after recovery. Child Pugh Class C patients require permanent discontinuation of medication.

3. Key points for stopping medication for special populations

(1) Child patients

Children aged 2-12 need to extend the reduction period to 2-4 weeks and monitor their growth and development indicators. Premature infants should avoid using oral suspensions.

(2) Elderly patients

Patients aged 65 and above need to continue monitoring liver function for 2 months after discontinuing medication, as drug clearance may be delayed.

(3) Renal insufficiency

For patients with creatinine clearance rate<30mL/min who switch to oral formulations, the reduction period still needs to be extended by more than one week.

4. Drug interaction management

After discontinuing fluconazole, it is necessary to adjust the dosage of co administered immunosuppressants (such as cyclosporine). CYP2C19 slow metabolizers have a slower decrease in drug concentration after discontinuation, and the monitoring period needs to be extended.