Subtherapeutic posaconazole prophylaxis in a gastric bypass patient following hematopoietic stem cell transplantation
| Autor: | Emily A Highsmith, Vi P Doan, Todd W. Canada |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
0301 basic medicine
Male medicine.medical_specialty Posaconazole Malabsorption Antifungal Agents medicine.medical_treatment 030106 microbiology Gastric Bypass Case Report Hematopoietic stem cell transplantation Gastroenterology Intestinal absorption 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans Medical history 030212 general & internal medicine Pharmacology business.industry Health Policy intestinal absorption Middle Aged Triazoles medicine.disease posaconazole Diarrhea Parenteral nutrition surgical procedures operative Failure to thrive hematopoietic stem cell transplantation AcademicSubjects/MED00410 medicine.symptom business medicine.drug |
| Zdroj: | American Journal of Health-System Pharmacy: AJHP |
| ISSN: | 1535-2900 1079-2082 |
| Popis: | Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose A case of invasive fungal infections (IFIs) with subtherapeutic posaconazole prophylaxis in a gastric bypass patient following hematopoietic stem cell transplantation (HSCT) is reported. Summary A 52-year-old malnourished male with a medical history of Roux-en-Y gastric bypass for obesity developed acute myelogenous leukemia and underwent allogeneic HSCT approximately 17 months later. He was admitted 1 month after HSCT for failure to thrive and initiated on parenteral nutrition due to worsening diarrhea and suspected gastrointestinal graft-versus-host disease (GI GVHD). During admission, the patient was continued on daily oral posaconazole for antifungal prophylaxis and was found to have subtherapeutic posaconazole and deficient vitamin levels, likely secondary to his gastrojejunostomy and increased gastric transit time. The oral posaconazole was altered to twice-daily dosing in an effort to increase serum drug levels and prevent IFIs. Conclusion Patients with a history of gastric bypass are at increased risk for malabsorption of oral posaconazole and nutrients, especially following HSCT with suspected GI GVHD. |
| Databáze: | OpenAIRE |
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