Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 42, 20251, Hamburg, Germany.
Infection. 2023 Dec;51(6):1767-1772. doi: 10.1007/s15010-023-02078-9. Epub 2023 Jul 27.
Posaconazole is an antifungal drug currently being used for prophylaxis and treatment of invasive fungal infections such as aspergillosis. To date, therapeutic drug monitoring (TDM) of posaconazole is recommended with the use of oral suspension, but the potential need of TDM with the use of IV formulations is rising. Therefore, we aimed to investigate the pharmacokinetics of IV posaconazole in critically ill patients.
In a prospective study, we analysed 168 consecutivelly collected posaconazole levels from 10 critically ill patients drawn during a 7 day curse. Posaconazole concentrations were measured using a chromatographic method. Demographic and laboratory data were collected, and the data was analysed using descriptive statistics.
We included 168 posaconazole levels, resulting in a median trough of 0.62 [0.29-1.05] mg/L with 58% not reaching the suggested target of 0.5 mg/L for fungal prophylaxis. Moreover, 74% of the trough levels were under the target of 1 mg/L which is proposed for the treatment of aspergillosis.
Posaconazole exposure is highly variable in critically ill patients resulting in potentially insufficient drug concentrations in many cases. TDM is highly recommended to identify and avoid underexposure.
NCT05275179, March 11, 2022.
泊沙康唑是一种抗真菌药物，目前用于预防和治疗侵袭性真菌感染，如曲霉菌病。迄今为止，建议使用口服混悬液进行泊沙康唑的治疗药物监测（TDM），但随着 IV 制剂的使用，TDM 的潜在需求正在增加。因此，我们旨在研究重症患者 IV 泊沙康唑的药代动力学。
在一项前瞻性研究中，我们分析了 10 名重症患者在 7 天疗程中连续采集的 168 个泊沙康唑水平。使用色谱法测量泊沙康唑浓度。收集人口统计学和实验室数据，并使用描述性统计进行数据分析。
我们纳入了 168 个泊沙康唑水平，结果中位数谷浓度为 0.62 [0.29-1.05]mg/L，58%的患者未达到预防真菌感染的 0.5mg/L 的建议目标。此外，74%的谷浓度低于建议用于治疗曲霉菌病的 1mg/L 的目标。
重症患者的泊沙康唑暴露情况高度可变，导致许多情况下药物浓度可能不足。强烈建议进行 TDM 以识别和避免药物暴露不足。
NCT05275179，2022 年 3 月 11 日。
