Selvy N, Villiet M, Hansel-Esteller S
Service de pharmacie, CHRU de Montpellier, hôpital Lapeyronie, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France.
Pathol Biol (Paris). 2010 Apr;58(2):123-6. doi: 10.1016/j.patbio.2009.07.016. Epub 2009 Oct 27.
OBJECTIVE OF THIS STUDY: The mortality level of leucemic patient's fungal infections can reach 70%. Antifungal prophylaxis posaconazole (P) is used during severe and prolonged neutropenia resulting from chemotherapy for acute myelogenous leukemia (AML), myelodysplastic syndrome and after autologous transplant.
We realized a retrospective study in order to assess the efficiency of P. Oral prophylaxy dosage is 200mg every eight hours to beginning before presumed neutropenia. Treatment failure was defined as the occurrence of proven/probable invasive fungal infections (IFI), receipt of any other systemic antifungal agent for suspected IFI or for impossible swallowing and the occurrence of adverse event. The objective is to note down the incidence of proven/probable IFI prevented by P.
We included 22 patients of whom 86% suffered from AML. P was prescribed in IFI prophylaxies during prolonged and severe neutropenia postchemotherapy (72%) or postautologous transplant (28%) and initiated 7 days before neutropenia (50% of cases). The mean treatment period was 18 days. Colonization occurred in one third of patients (43% of Candida albicans). Esomeprazole (E) 40 mg was associated in 64% of cases. P prophylaxis failed in 50% of cases. Proven/probable IFI occurred in one case. Different failure causes were: suspected or possible IFI (n=5) and impossible swallowing (n=5).
P prophylaxis seems to be efficient among these high-risk patients. However, a P tardive initiation, an E association, P administration and resorption difficulties seem to have a importance in successful treatment. It would be interesting to optimize P treatment with plasmatic dosages to ensure efficiency and safety for patients.
本研究目的：白血病患者真菌感染的死亡率可达70%。抗真菌预防用药泊沙康唑（P）用于急性髓性白血病（AML）、骨髓增生异常综合征化疗及自体移植后导致的严重且长期中性粒细胞减少症期间。
我们进行了一项回顾性研究以评估P的疗效。口服预防剂量为每8小时200mg，在预计中性粒细胞减少症开始前用药。治疗失败定义为发生确诊/疑似侵袭性真菌感染（IFI）、因疑似IFI或吞咽困难而接受任何其他全身性抗真菌药物治疗以及发生不良事件。目的是记录P预防的确诊/疑似IFI的发生率。
我们纳入了22例患者，其中86%患有AML。P在化疗后（72%）或自体移植后（28%）的长期严重中性粒细胞减少症的IFI预防中使用，在中性粒细胞减少症前7天开始用药（50%的病例）。平均治疗期为18天。三分之一的患者发生定植（白色念珠菌占43%）。64%的病例联合使用了40mg埃索美拉唑（E）。P预防在50%的病例中失败。确诊/疑似IFI发生1例。不同的失败原因有：疑似或可能的IFI（n = 5）和吞咽困难（n = 5）。
P预防在这些高危患者中似乎有效。然而，P开始用药延迟、联合使用E、P给药和吸收困难似乎对成功治疗具有重要影响。通过血浆剂量优化P治疗以确保患者的疗效和安全性将是很有意义的。
