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Posaconazole salvage treatment for invasive fungal infection : a single center experience with utilization of posaconazole oral suspension or delayed-released tablet

Session: Poster Abstract Session: Fungal Infections
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background: Posaconazole has a broad spectrum antifungal activity and it may be useful for salvage antifungal treatment for invasive fungal infection (IFI). The aim of this study was to evaluate the efficacy and outcomes of posaconazole salvage treatment (ST) in patients with IFI who were intolerant or refractory to other antifungal therapy with utilization of posaconazole oral suspension (os) or delayed-released tablet (tab).   

Methods: A retrospective review of patients who were started on posaconazole ST for IFI at our institution between December 2007 and March 2014 was conducted.

Results: A total of 25 episodes of posaconazole ST for IFI in 23 patients were identified. Median age was 55 years and the majority of patients had hematologic disease (70%, 16/23). Classifications of 25 episodes of IFI were proven (12), probable (5), and possible (8). Etiology of 25 episodes of IFI included mucormycosis (7), Paecilomyces variotii (1), Aspergillus fumigatus (2), Alternaria spp.(2), and unspecified IFI etiology without positive culture (13). Reasons for posaconazole ST were : intolerance of previous antifungal therapy in 12 episodes, refractory IFI on previous antifungal therapy in 9 episodes, both intolerance and refractory IFI on previous antifungal therapy in 1 episode, and transition to long-term maintenance in 3 episodes. Posaconazole os and tab was used in 19 episodes and in 6 episodes, respectively. Duration of posaconazole ST ranged from 15 to 370 days with median 52 days. Posaconazole ST with tab (300mg twice daily loading on the first day and followed by 300mg daily) seemed to achieve favourable therapeutic posaconazole trough concentrations (range 0.9 – 5.8 ug/mL, median 2.0 ug/ml) compared to posaconazole os (800mg daily, range 0.1 – 3.6 ug/mL, median 1.0 ug/mL), P=0.008. The overall successful posaconazole ST response rate was 64% (16 of 25 episodes from 3 tab recipients and 13 os recipients : 10 partial and 6 complete clinical and radiologic responses). There were 5 patients who died during the study period. However, only one death was attributed to the progression of IFI. Adverse events were noted in 4 patients with discontinuation of posaconazole in 3 patients.

Conclusion: Posaconazole ST may be used effectively for IFI. More studies are required to define the optimal antifungal therapeutic strategy.

Jong Hun Kim, MD, Division of Infectious Diseases, Department of Internal Medicine, University of Utah, Salt Lake City, UT and Kali Williams, PharmD, University of Utah, Salt Lake City, UT


J. H. Kim, Merck: an investigator initiated grant , Research grant

K. Williams, None

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