Department of Infectious Diseases, Deenanath Mangeshkar Hospital, Pune, India.
Department of Infectious Diseases, Deenanath Mangeshkar Hospital, Pune, India.
Int J Infect Dis. 2022 Nov;124:76-80. doi: 10.1016/j.ijid.2022.09.004. Epub 2022 Sep 9.
Posaconazole is a broad-spectrum triazole antifungal, with activity against various clinically important fungi. The delayed release (DR) tablet of posaconazole has been shown to have a superior pharmacokinetic profile in comparison with the oral suspension.
We retrospectively analyzed the factors associated with posaconazole levels <1.25 μg/ml in 164 patients receiving the DR tablet for therapeutic purposes.
Of the 164 patients, 53 (32.3%) showed subtherapeutic trough levels of posaconazole. The use of proton pump inhibitors (95% CI 1.41-3.91; P-value = 0.028) and the presence of diarrhea (95% CI 1.95-6.93; P-value = 0.001) were significantly associated with subtherapeutic levels. A total of 13 of the 21 patients receiving posaconazole tablets through a nasogastric tube had therapeutic levels.
This is the largest study from India that analyzed factors associated with subtherapeutic levels of the DR tablet of posaconazole. These findings reinforce the importance of therapeutic drug monitoring. Unlike in previous studies, obesity and hypoalbuminemia were not found to be significant factors in our settings. The use of proton pump inhibitors and diarrhea remained significant factors, as found in previous studies. Administering the DR tablet of posaconazole through a nasogastric tube may be a viable option.
泊沙康唑是一种广谱三唑类抗真菌药物，对各种临床上重要的真菌均具有活性。与口服混悬液相比，泊沙康唑延迟释放（DR）片剂具有更优的药代动力学特征。
我们回顾性分析了 164 例接受泊沙康唑 DR 片剂治疗的患者中，其泊沙康唑水平<1.25μg/ml 的相关因素。
在 164 例患者中，53 例（32.3%）显示泊沙康唑的谷浓度低于治疗水平。质子泵抑制剂的使用（95%CI 1.41-3.91；P 值=0.028）和腹泻的存在（95%CI 1.95-6.93；P 值=0.001）与治疗水平显著相关。在通过鼻胃管接受泊沙康唑片剂治疗的 21 例患者中，有 13 例达到了治疗水平。
这是印度最大的一项分析泊沙康唑 DR 片剂治疗水平较低相关因素的研究。这些发现强调了治疗药物监测的重要性。与之前的研究不同，在我们的研究环境中，肥胖症和低白蛋白血症并不是显著因素。质子泵抑制剂的使用和腹泻仍然是重要因素，与之前的研究结果一致。通过鼻胃管给予泊沙康唑 DR 片剂可能是一种可行的选择。
