antifungal agents; bile; Candida; concentration; dosing; fluconazole; guidelines; cholangitis; cholecystitis; penetration; personalized; pharmacokinetics; society; tdm; trough

Candida and other fungal species play an increasing role in nosocomial infections, including cholangitis and cholangiosepsis. Early diagnosis and prompt treatment are essential in successful patient outcomes. Fluconazole is an antifungal of choice in fluconazole-sensitive Candida infections. Little information is known about the fluconazole biliary excretion. Decreased tissue penetration may be one of the possible causes of treatment failure. Due to favorable pharmacokinetics, therapeutic drug monitoring of this antifungal has not been recommended routinely. In the presented case we report the successful therapeutic drug monitoring-guided fluconazole treatment in a patient with cholangitis and cholangiosepsis caused by fluconazole-sensitive Candida spp. Lay abstract A successful fluconazole treatment of Candida cholangitis based on therapeutic drug monitoring, is described in our case study. Unlike other azole antimycotic agents, fluconazole is not considered a desirable candidate for therapeutic drug monitoring. However, as shown in our case study, a fixed dosage regimen might not lead to adequate fluconazole exposure in every patient and a personalized dosing regimen might be useful in the achievement of adequate fluconazole exposure and the successful treatment of Candida infection.