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Posaconazole in lung transplant recipients: use, tolerability, and efficacy
Author(s) -
Robinson C.L.,
Chau C.,
Yerkovich S.T.,
Azzopardi M.,
Hopkins P.,
Chambers D.
Publication year - 2016
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12497
Subject(s) - medicine , tolerability , tacrolimus , posaconazole , adverse effect , lung , lung transplantation , retrospective cohort study , transplantation , gastroenterology , surgery , antifungal , itraconazole , dermatology
Background Fungal infection is a common cause of mortality and morbidity in lung transplant recipients (Lu TR ). Treatment failure to first‐line antifungals because of resistance or intolerance is an increasing problem. Posaconazole ( PCZ ), a triazole antifungal, is an attractive treatment option. Methods We performed a single‐center retrospective study to describe the use, tolerability, efficacy, and drug interaction effect (with tacrolimus) of PCZ oral suspension in Lu TR . Results Seventy‐eight patients were treated with PCZ oral suspension for prophylaxis ( n = 15), pre‐emptive treatment ( n = 31), and treatment of possible ( n = 7) and probable ( n = 25) invasive fungal infection. A range of fungal isolates was encountered. Resolution was observed in 52.4% (probable, possible, and pre‐emptive treatment groups). Aggregate all‐cause 1‐year mortality was 12.8%. PCZ was well tolerated with 11.5% of patients experiencing adverse effects. Despite dose adjustment strategies, 11.7% of patients experienced supratherapeutic tacrolimus levels, which in 5 cases was associated with a rise (mean 21.6 μmol/L) in serum creatinine. Conclusions PCZ is well tolerated and appears effective in the management of fungal infection after lung transplantation. Patients receiving concurrent tacrolimus require careful therapeutic drug monitoring.