Switching antifungals drugs within the triazole drug class: a potential treatment approach to drug-related hepatotoxicity

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.