Document Detail


Therapeutic drug monitoring of posaconazole: a monocentric study with 54 adults.
MedLine Citation:
PMID:  19752284     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Posaconazole is a potent broad-spectrum triazole antifungal. Little is known about the prevalence and risk factors for low plasma posaconazole concentrations (PPCs). We retrospectively reviewed all adult patients whose PPCs were measured after at least 5 days of treatment between April 2006 and July 2008 at the Hôpital Necker Enfants Malades. A low PPC was defined as a concentration lower than 500 ng/ml. Fifty-four patients were included: 36 receiving prophylactic (200 mg three times a day) and 18 receiving curative (400 mg twice a day) posaconazole therapy. The prevalence of low PPCs was 44% (16/36) in the prophylaxis group and 22% (4/18) in the curative-treatment group. In the prophylaxis group, low PPCs tended to be more frequent in cases of digestive disease (62.5% versus 30%; P = 0.051) and were significantly more frequent among patients with diarrhea (71.4% versus 27%; P = 0.009) or mucositis (100% versus 33%; P = 0.004). In the curative-treatment group, low PPCs were significantly more frequent in cases of diarrhea (75% versus 7%; P = 0.018). In the prophylaxis group, the only two patients who subsequently developed invasive fungal infections exhibited low PPCs. The only adverse event was hepatotoxicity for 2/54 patients (3.7%), which was not related to high plasma drug concentrations. In conclusion, low PPC is common, significantly more frequent in cases of diarrhea or mucositis, and potentially associated with subsequent invasive fungal infection. Therapeutic drug monitoring of posaconazole is therefore mandatory for immunosuppressed adults, at least for those with gastrointestinal disorders.
Authors:
David Lebeaux; Fanny Lanternier; Caroline Elie; Felipe Suarez; Agnès Buzyn; Jean-Paul Viard; Marie-Elisabeth Bougnoux; Marc Lecuit; Vincent Jullien; Olivier Lortholary
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Publication Detail:
Type:  Journal Article     Date:  2009-09-14
Journal Detail:
Title:  Antimicrobial agents and chemotherapy     Volume:  53     ISSN:  1098-6596     ISO Abbreviation:  Antimicrob. Agents Chemother.     Publication Date:  2009 Dec 
Date Detail:
Created Date:  2009-11-17     Completed Date:  2010-02-01     Revised Date:  2013-11-25    
Medline Journal Info:
Nlm Unique ID:  0315061     Medline TA:  Antimicrob Agents Chemother     Country:  United States    
Other Details:
Languages:  eng     Pagination:  5224-9     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Antifungal Agents / adverse effects,  therapeutic use*
Diarrhea / blood,  drug therapy
Drug Monitoring / methods*
Female
Humans
Male
Middle Aged
Mucositis / blood,  drug therapy
Mycoses / drug therapy*,  prevention & control
Retrospective Studies
Triazoles / adverse effects,  blood,  therapeutic use*
Chemical
Reg. No./Substance:
0/Antifungal Agents; 0/Triazoles; 6TK1G07BHZ/posaconazole
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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