Actions
  • shareshare
  • link
  • cite
  • add
add
auto_awesome_motion View all 2 versions
Other research product . Other ORP type . 2019

Posaconazole therapeutic drug monitoring in clinical practice and longitudinal analysis of the effect of routine laboratory measurements on posaconazole concentrations

Märtson, Anne Grete; Veringa, Anette; van den Heuvel, Edwin R.; Bakker, Martijn; Touw, Daan J.; van der Werf, Tjip S.; Span, Lambert F.R.; +1 Authors
Open Access
English
Published: 01 Aug 2019
Abstract
Posaconazole is indicated for prophylaxis and treatment of invasive aspergillosis. Therapeutic drug monitoring (TDM) of posaconazole is used to optimise drug exposure. The aim of this study was to analyse and describe the TDM practices and exposure of posaconazole tablets. Patients who received posaconazole for treatment or prophylaxis of fungal infections were included in the study. The following therapeutic window was defined: if concentration was low (3.75 mg/L), the hospital pharmacist provided the physician with dosage advice, which implementation to patient care was analysed. A longitudinal analysis was performed to analyse if different confounding variables had an effect on posaconazole concentrations. Forty-seven patients were enrolled resulting in 217 posaconazole trough concentrations. A median of 3 (IQR 1-7) samples was measured per patient. The median concentration was 1.7 mg/L (IQR 0.8-2.7) for prophylaxis and 1.76 mg/L (IQR 1.3-2.3) for treatment. Overall, 78 posaconazole concentrations were out of the therapeutic window. For 45 (54%) of these concentrations, a dosage change was recommended. In the longitudinal analysis, the laboratory markers and patient baseline variables did not have an effect on posaconazole concentrations. Adequate posaconazole exposure was shown in 64% (affected 28 patients) of the measured concentrations. TDM practice of posaconazole can be improved by increasing the implementation rate of dose recommendation by a multidisciplinary antifungal stewardship team.
Subjects

clinical pharmacy, haematological malignancies, invasive fungal infections, longitudinal analysis, pharmacist, pharmacokinetics, posaconazole, therapeutic drug monitoring, INFECTIOUS-DISEASES SOCIETY, ANTIMICROBIAL STEWARDSHIP, TABLET FORMULATION, 2016 UPDATE, SAFETY, PHARMACISTS, EXPOSURE, ASPERGILLOSIS, PROPHYLAXIS, Invasive Fungal Infections/drug therapy, Prospective Studies, Tablets, Administration, Oral, Clinical Laboratory Techniques, Humans, Middle Aged, Triazoles/blood, Male, Dose-Response Relationship, Drug, Antifungal Agents/blood, Female, Aged, Drug Monitoring, Longitudinal Studies, SDG 3 - Good Health and Well-being

Related Organizations

1. dSegal BH. Aspergillosis. N Engl J Med. 2009;360(18):1870-1884. doi:10.1056/NEJMra0808853.

2. eDrew RH, Townsend ML, Pound MW, Johnson SW, Perfect JR. Recent advances in the ttreatment of life-threatening, invasive fungal infections. Expert Opin Pharmacother. 2013;14(17):2361-2374. doi:10.1517/14656566.2013.838217.

3. pPatterson TF, Thompson George R. III, Denning DW, et al. Practice Guidelines for the eDiagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2016;63(4):e1-e60. c http://dx.doi.org/10.1093/cid/ciw326.

4. cPappas PG, Kauffman CA, Andes DR, et al. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of AAmerica. Clin Infect Dis. 2016;62(4):e1-50. doi:10.1093/cid/civ933. severe graft-versus-host disease. N Engl J Med. 2007;356(4):335-347.

r doi:10.1056/NEJMoa061098.

8. 2019. doi:10.1016/j.ijantimicag.2019.01.006.

Funded by
EC| PRONKJEWAIL
Project
PRONKJEWAIL
Protecting patients with enhanced susceptibility to infections
  • Funder: European Commission (EC)
  • Project Code: 713660
  • Funding stream: H2020 | MSCA-COFUND-DP
Download fromView all 2 sources
lock_open
NARCIS
Other ORP type . 2019
Providers: NARCIS
moresidebar