| Autor: |
Bui J; Clinical Pharmacy Department, Royal North Shore Hospital, Sydney, Australia.; Department of Infectious Diseases, Royal North Shore Hospital, Sydney, Australia., Gellatly R; Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia.; Pharmacy Department, Surrey Memorial Hospital, Surrey, Canada., Othman J; Haematology Department, Royal North Shore Hospital, Sydney, Australia., Lindsay J; Haematology Department, Royal North Shore Hospital, Sydney, Australia.; National Centre for Infection in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia.; Vaccine and Infectious Disease and Clinical Research Division, Fred Hutchinson Cancer Research Center, SE, USA. |
| Abstrakt: |
Posaconazole is indicated for antifungal prophylaxis in hematology patients at high-risk of invasive fungal infections (IFI). Consensus guidelines recommend maintaining steady-state trough concentrations above 0.7 mg/L; however, upto one-third of patients return subtherapeutic concentrations which is associated with breakthrough IFI. This retrospective observational study of 496 concentrations from 90 hematology inpatients prescribed posaconazole tablet (PCZ-tab) between May 2017 and May 2019 identified 24% ( n = 121) of posaconazole concentrations were subtherapeutic after the dosage of 300 mg daily. On multivariable analyses, diarrhea ( p = 0.002), male gender ( p = 0.018), and concurrent regular metoclopramide ( p = 0.002) were significantly associated with subtherapeutic posaconazole concentrations. Eighty-nine percent of patients ( n = 16) who underwent dose adjustment to 200 mg twice daily successfully achieved target posaconazole concentrations at first steady-state measurement. This study confirms that therapeutic drug monitoring of posaconazole remains necessary as subtherapeutic posaconazole concentrations are relatively common, and that dose adjustment of 200 mg twice daily, safely enabled achievement of therapeutic concentrations. |
