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w use than for the adjacent peak levels. Finally, the meropenem peak level during the second period of CytoSorb w use was substantially lower than the peak level before use. The observed substantially lower linezolid peak levels during CytoSorb w use might be due to adsorption by the cytokine filter. Indeed, different endogenous substances, apart from cytokines, are reported to be adsorbed by cytokine filters. 6 Adsorption would also explain the lower peak level of meropenem during the second use of CytoSorb w. However, blood samples were not collected at optimal timepoints for meropenem; hence, the information for this antibiotic is limited. It should be mentioned that the high intra-individual variability observed for both antibiotics might also be due to the effects of critical illness. 4,7 However, because of the possible adsorption of antibiotics by cytokine filters , therapeutic drug monitoring (TDM) might be especially important for patients using such systems. Indeed, first guidelines already recommended the use of TDM in critically ill patients. 8,9 If TDM is not available, high loading doses or shorter intervals between antibiotic administrations could be used to achieve adequate antibiotic levels. The results suggest that further studies are needed to understand the impact of cytokine filters on the concentrations of different antimicrobials. None to declare. We affirm that this manuscript is an honest, accurate and transparent account of the case being reported, and that no important aspects of the case have been omitted. 2 Reiter K, Bordoni V, Dall'Olio G et al. In vitro removal of therapeutic drugs with a novel adsorbent system. A et al. Quantification of piperacillin, tazobactam, cefepime, meropenem, ciprofloxacin and linezolid in serum using an isotope dilution UHPLC-MS/MS method with semi-automated sample preparation. 4 Zoller M, Maier B, Hornuss C et al. Variability of linezolid concentrations after standard dosing in critically ill patients: a prospective observational study. An international, multicentre survey of b-lactam antibiotic therapeutic drug monitoring practice in intensive care units. 6 Kuntsevich VI, Feinfeld DA, Audia PF et al. In-vitro myoglobin clearance by a novel sorbent system. 7 Roberts JA, Abdul-Aziz MH, Lipman J et al. Individualised antibiotic dosing for patients who are critically ill: challenges and potential solutions. Sir, Voriconazole is a broad-spectrum triazole used in the treatment of many fungal infections including those caused by Scedosporium spp. Along with significant side effects, voriconazole has a variable metabolism and multiple drug interactions, requiring regular monitoring. We present …

Interaction between voriconazole and flucloxacillin during treatment of disseminated Scedosporium apiospermum infection