Fungal infections have emerged as an increasingly serious public health challenge globally. Four Formulations of amphotericin B are widely used in antifungal therapy. Despite the same active ingredient, they probably differ in efficacy, safety and economics.

This study aimed to explore the differences in efficacy, safety and economy among different formulations of amphotericin B in patients with IFD.

We conducted a retrospective study at a tertiary hospital, examining patients who were administered amphotericin B from June 2023 to March 2025, to assess the efficacy, safety and economy of different amphotericin B Formulations in invasive fungal disease.

(1) A total of 71 patients were included. Patients with potential renal injury are more likely to choose liposomal amphotericin B (p = 0.021). (2) Liposomal amphotericin has the accelerated therapeutic onset (p = 0.042), amphotericin B deoxycholate has the delayed therapeutic effect (p = 0.031), the effective response of liposomal amphotericin B in elders was significantly lower (p = 0.022), and the counterpart of amphotericin B deoxycholate in females was significantly higher (p = 0.01). (3) The main adverse events of the three amphotericin B formulations were kidney injury (p < 0.001), there was no significant inter-group difference. (4) The amphotericin B deoxycholate group incurred the most economical total cost (p < 0.01), daily cost (p < 0.01) and cost-effectiveness.

Amphotericin B formulations exhibit marked variations in efficacy and economy profiles, necessitating individualized selection guided by specific clinical characteristics. Rigorous monitoring of renal function remains imperative throughout the therapeutic course.

To investigate the factors influencing venlafaxine blood concentration exceeding the alert threshold in patients with depression and to develop a risk prediction model for elevated venlafaxine concentrations, providing a reference for individualized VEN therapy.

A retrospective analysis was conducted on 590 hospitalized patients who received venlafaxine treatment and underwent TDM at the First Hospital of Hebei Medical University between January 2021 and August 2024. Patients were categorized into a target concentration group (100–400 ng/mL) and an above-alert group (> 800 ng/mL) based on their VEN plasma concentrations. Demographic and clinical variables, including sex, age, body mass index (BMI), average daily dose, plasma albumin level, concomitant medications, liver and kidney function, were collected and compared between groups. Logistic regression analysis was performed to identify independent risk factors associated with VEN concentrations exceeding the alert threshold. A nomogram prediction model was constructed based on the identified factors and was subsequently validated.

Among the 590 patients, 516 were in the target concentration group and 74 were in the above-alert group. The proportion of females, patients with BMI < 24, average daily dose ≥ 225 mg, renal impairment, and concomitant use of CYP2D6 inhibitors was significantly higher in the above-alert group than in the target group (P < 0.05). Logistic regression analysis revealed that average daily dose ≥ 225 mg (OR = 26.628, 95 % CI: 12.912–54.916), renal impairment (OR = 2.429, 95 % CI: 1.215–4.854), and concomitant use of CYP2D6 inhibitors (OR = 5.232, 95 % CI: 2.781–9.844) were independent risk factors for VEN concentrations exceeding the alert threshold (P < 0.05). The nomogram model showed an AUC of 0.899 (95 % CI: 0.864–0.935), sensitivity of 48.65 %, specificity of 95.74 %, positive predictive value of 62.07 %, and negative predictive value of 92.86 %. Bootstrap validation demonstrated good consistency (Brier score = 0.072), and the Hosmer-Lemeshow test indicated good calibration (χ² = 3.16, P = 0.531). Decision curve analysis demonstrated clinical utility for threshold probabilities of 0.05–0.80.

Average daily dose ≥ 225 mg, renal impairment, and concomitant use of CYP2D6 inhibitors are independent risk factors for VEN plasma concentrations exceeding the alert threshold. The constructed nomogram model effectively predicts the risk of venlafaxine concentration exceeding the alert range and has significant clinical application value.

Posaconazole (PCZ) has been used to prevent and treat invasive fungal infections in immunocompromised patients with hematological malignancies. There is a significant correlation between plasma drug concentration and the efficacy of posaconazole.

This study aimed to investigate the effects of glucocorticoid on PCZ C_min and on the outcome of PCZ prevention/treatment of invasive fungal infections.

We conducted a retrospective study at a tertiary hospital, examining patients who were administered posaconazole oral suspension between September 2021 and September 2023, to assess the effect of glucocorticoid on the plasma drug concentration and antifungal effect of posaconazole.

(Ⅰ) The concomitant usage of glucocorticoid reduced PCZ C_min from 1310.00 (648.48，2550.00) ng/mL to 1085.00 (529.79，1767.50) ng/mL (p = 0.032), and the C_min/Dose (C/D) decreased from 2.14 (0.98, 4.10) ng/mL/mg to 1.66 (0.86, 2.73) ng/mL/mg (p = 0.038). (Ⅱ) There was a significant difference in PCZ C_min between patients on low-dose glucocorticoids and those on medium & high-dose glucocorticoids (1271.14 vs 720.19 ng/mL, p < 0.001). (Ⅲ) PCZ C_min was significantly lower in patients with longer glucocorticoid duration than with shorter (p = 0.013). (Ⅳ) Compared with PCZ alone, the concomitant usage of PPIs, glucocorticoids, and PPIs & glucocorticoids significantly reduced PCZ C_min (p < 0.001, p= 0.001, p= 0.001).

The concomitant usage of glucocorticoid can significantly reduce PCZ C_min, and this decrease has a correlation with the dose and duration of glucocorticoid. However, glucocorticoid may not affect the clinical outcome of posaconazole in the prevention/treatment of invasive fungal infections.