Subtherapeutic posaconazole troughs despite high-dose posaconazole tablets in a patient with terminal ileum resection
| Autor: | Si Lin Sarah Tang, Si Yun Melinda Tan, Ban Hock Tan, Lay Hoon Andrea Kwa, Thuan Tong Tan, Tze-Peng Lim, Peijun Yvonne Zhou, Hui Ling Winnie Lee, Gee Chuan Wong |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Microbiology (medical)
medicine.medical_specialty Posaconazole Ileum Gastroenterology Article Text mining Internal medicine medicine Humans Leukemia business.industry Terminal Ileum Resection Myelodysplastic syndromes Micafungin Triazoles bacterial infections and mycoses medicine.disease Infectious Diseases medicine.anatomical_structure Myelodysplastic Syndromes lipids (amino acids peptides and proteins) business Tablets medicine.drug |
| Zdroj: | Journal of Infection. 78:409-421 |
| ISSN: | 0163-4453 |
| Popis: | OBJECTIVES: To compare the effectiveness and tolerability of micafungin versus posaconazole during chemotherapy-induced neutropenia in acute leukemia (AL) and myelodysplastic syndrome (MDS). METHODS: Patients with AL or MDS undergoing chemotherapy were randomized to open-label micafungin 100 mg intravenously daily or posaconazole suspension 400 mg orally twice daily until neutrophil recovery, up to 28 days. Patients were followed for 12 weeks. The primary endpoint was prophylaxis failure (premature discontinuation due to infection, intolerance, adverse event, or death). Time to failure and survival were calculated by Kaplan-Meier analysis. RESULTS: From March 2011 to May 2016, 113 patients who received at least 2 doses of prophylaxis were analyzed (58 patients randomized to micafungin and 55 to posaconazole). Prophylaxis failure occurred in 34.5% and 52.7% of patients on micafungin and posaconazole, respectively (P = 0.0118). The median number of days on prophylaxis was 16 [interquartile range (IQR) 12-20] for micafungin and 13 [IQR 6-16] for posaconazole (P = 0.01). Micafungin failures were largely due to antifungal treatment; posaconazole failures were mostly due to gastrointestinal intolerance or adverse effects. IFI incidence and survival were similar between study arms. CONCLUSIONS: Our data support micafungin as alternative antifungal prophylaxis in patients with AL and MDS. |
| Databáze: | OpenAIRE |
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