Clinical effectiveness of early posaconazole suspension pre-emptive therapy in lung transplant recipients: The Alfred's experience

• Main Authors: Ivulich, S. (Author), Jeong, W. (Author), Kong, D.C.M (Author), Levvey, B.J (Author), Neoh, C.F (Author), Orla Morrissey, C. (Author), Slavin, M.A (Author), Snell, G.I (Author), Westall, G.P (Author)
• Format: Article
• Language: English
• Published: Oxford University Press 2017
• Subjects: adult; Adult; antifungal agent; Antifungal Agents; Article; aspergillosis; Aspergillosis; Aspergillus fumigatus; Aspergillus niger; Aspergillus terreus; blood; clinical article; clinical effectiveness; clinical outcome; cohort analysis; Cohort Studies; drug effects; drug monitoring; Drug Monitoring; drug tolerability; drug withdrawal; eradication therapy; female; Female; fungal colonization; fungus isolation; Fusarium; graft recipient; human; Humans; isolation and purification; liver dysfunction; lung transplantation; Lung Transplantation; male; Male; microbiology; middle aged; Middle Aged; minimum plasma concentration; nausea; nonhuman; observational study; Paecilomyces; posaconazole; Retrospective Studies; retrospective study; Scedosporium apiospermum; Scopulariopsis; suspension; Suspensions; Transplant Recipients; treatment outcome; Treatment Outcome; triazole derivative; Triazoles; vomiting; voriconazole; Voriconazole
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 Objectives: This study describes the clinical outcomes and therapeutic drug monitoring (TDM) following posaconazole suspension pre-emptive therapy in lung transplant (LTx) recipients. Methods: This was a single-centre, retrospective cohort study evaluating posaconazole suspension pre-emptive therapy in LTx recipients between January 2009 and December 2015. Results: Forty-two LTx recipients were prescribed posaconazole suspension pre-emptively. Aspergillus fumigatus was the most commonly isolated fungal organism. Of the patients receiving posaconazole suspension as the initial antifungal post-LTx, 93% had eradication of colonization at 6months after commencing therapy. In contrast, only 61% had eradication of fungal colonization when posaconazole suspension was administered following initial therapy with voriconazole. Posaconazole suspension appeared to be well tolerated, although one case was curtailed following concern about abnormal liver function and another due to nausea/vomiting. TDM was performed in 37 patients. The initial median (IQR) trough plasma concentration (Cmin) following 400mg twice-daily posaconazole suspension was 0.78 (0.46-1.19) mg/L. Doses beyond 800mg daily did not appear to result in a higher median Cmin Conclusions: Early initiation of posaconazole suspension pre-emptive therapy in LTx recipients appears to be well tolerated and may potentially afford favourable clinical outcomes. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.