肺移植受者中早期泊沙康唑混悬液抢先治疗的临床疗效：Alfred 医院的经验。

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

机构信息

Centre for Medicine Use and Safety, Monash University, VIC, Australia.

Lung Transplant Service, Alfred Health & Monash University, VIC, Australia.

出版信息

J Antimicrob Chemother. 2017 Jul 1;72(7):2089-2092. doi: 10.1093/jac/dkx085.

DOI:10.1093/jac/dkx085

PMID:28369489

Abstract

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 6 months 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 ( C min ) following 400 mg twice-daily posaconazole suspension was 0.78 (0.46-1.19) mg/L. Doses beyond 800 mg daily did not appear to result in a higher median C min.

CONCLUSIONS

Early initiation of posaconazole suspension pre-emptive therapy in LTx recipients appears to be well tolerated and may potentially afford favourable clinical outcomes.

摘要

目的

本研究描述了肺移植（LTx）受者接受泊沙康唑混悬液抢先治疗后的临床结果和治疗药物监测（TDM）。

方法

这是一项单中心回顾性队列研究，评估了 2009 年 1 月至 2015 年 12 月期间 LTx 受者接受泊沙康唑混悬液抢先治疗的情况。

结果

42 例 LTx 受者接受了泊沙康唑混悬液抢先治疗。烟曲霉是最常分离的真菌病原体。在开始 LTx 后接受泊沙康唑混悬液作为初始抗真菌治疗的患者中，93%在开始治疗后 6 个月时定植被根除。相比之下，当泊沙康唑混悬液在初始给予伏立康唑治疗后使用时，只有 61%的患者真菌定植被根除。泊沙康唑混悬液似乎耐受性良好，尽管有 1 例因担心肝功能异常而中断，1 例因恶心/呕吐而中断。对 37 例患者进行了 TDM。400mg 每日 2 次泊沙康唑混悬液初始中位（IQR）谷浓度（Cmin）为 0.78（0.46-1.19）mg/L。每日剂量超过 800mg 似乎不会导致更高的中位 Cmin。