Therapeutic drug monitoring of posaconazole delayed release tablet while managing COVID-19-associated mucormycosis in a real-life setting

被引:10
作者
Patel, Atul [1 ]
Patel, Ketan [1 ]
Patel, Kamlesh [2 ]
Shah, Kinjal [1 ]
Chakrabarti, Arunaloke [3 ]
机构
[1] Sterling Hosp, Infect Dis Dept, Ahmadabad 380052, Gujarat, India
[2] Sterling Hosp, Dept Microbiol, Ahmadabad, Gujarat, India
[3] Postgrad Inst Med Educ & Res, Dept Med Microbiol, Chandigarh, India
关键词
COVID-19; mould infection; mucormycosis; posaconazole; therapeutic drug monitoring; toxicity; EXPOSURE-RESPONSE RELATIONSHIP;
D O I
10.1111/myc.13420
中图分类号
R75 [皮肤病学与性病学];
学科分类号
100206 ;
摘要
Background Along with COVID-19 pandemic, India has faced an outbreak of COVID-19-associated mucormycosis (CAM). Due to restricted availability of amphotericin B during this outbreak, clinicians were forced to use posaconazole or isavuconazole preparations as first-line or alternate therapy in many patients. We planned an early monitoring of posaconazole trough level while using delayed release (DR) tablet as first-line or alternate therapy. Objectives Primary objective of the study was to determine percentage of patients achieving arbitrarily decided therapeutic posaconazole levels (>= 1.2 mu g/ml) after using standard dosages of posaconazole. Secondary objective was to identify potential factors associated with sub-therapeutic posaconazole levels. Methods We performed retrospective chart review of the hospitalised patients, who received posaconazole DR tablet as first-line or alternate therapy to treat CAM during outbreak period (March 1 to May 31, 2021). High-performance liquid chromatographic (HPLC) method was used to measure trough level of posaconazole. Results Posaconazole serum levels of 29 patients were analysed, who received posaconazole DR tablet. Majority (n = 23) were male with the median (range) age 53 (24-86) years. The mean (SD) posaconazole level was 1.66 (0.76) mu g/ml. Sub-therapeutic posaconazole trough level was observed in 7 (24.1%) patients. Relatively younger patients were associated with lower posaconazole level (p = .046). Except two patients, all the patients tolerated posaconazole well. Conclusions The study supports the posaconazole trough level measurement on day 4 while using posaconazole DR tablet as first-line or alternate therapy to treat mucormycosis during limited supply of amphotericin B.
引用
收藏
页码:312 / 316
页数:5
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