[Prophylaxis use of posaconazole (P) in an hemato-oncology unit: a retrospective study].
OBJECTIVE OF THIS STUDY: The mortality level of leucemic patient's fungal infections can reach 70%. Antifungal prophylaxis posaconazole (P) is used during severe and prolonged neutropenia resulting from chemotherapy for acute myelogenous leukemia (AML), myelodysplastic syndrome and after autologous transplant.


METHODS
We realized a retrospective study in order to assess the efficiency of P. Oral prophylaxy dosage is 200mg every eight hours to beginning before presumed neutropenia. Treatment failure was defined as the occurrence of proven/probable invasive fungal infections (IFI), receipt of any other systemic antifungal agent for suspected IFI or for impossible swallowing and the occurrence of adverse event. The objective is to note down the incidence of proven/probable IFI prevented by P.


RESULTS
We included 22 patients of whom 86% suffered from AML. P was prescribed in IFI prophylaxies during prolonged and severe neutropenia postchemotherapy (72%) or postautologous transplant (28%) and initiated 7 days before neutropenia (50% of cases). The mean treatment period was 18 days. Colonization occurred in one third of patients (43% of Candida albicans). Esomeprazole (E) 40 mg was associated in 64% of cases. P prophylaxis failed in 50% of cases. Proven/probable IFI occurred in one case. Different failure causes were: suspected or possible IFI (n=5) and impossible swallowing (n=5).


CONCLUSIONS
P prophylaxis seems to be efficient among these high-risk patients. However, a P tardive initiation, an E association, P administration and resorption difficulties seem to have a importance in successful treatment. It would be interesting to optimize P treatment with plasmatic dosages to ensure efficiency and safety for patients.
Service de pharmacie, CHRU de Montpellier, hôpital Lapeyronie, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France.
N
N
Selvy
M
M
Villiet
S
S
Hansel-Esteller
D000328:Adult; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination; D064098:Esomeprazole / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D009190:Myelodysplastic Syndromes / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D009503:Neutropenia / Q000209:etiology; D016522:Oncology Service, Hospital; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D011292:Premedication; D012189:Retrospective Studies; D019172:Transplantation Conditioning / Q000009:adverse effects; D014182:Transplantation, Autologous; D017211:Treatment Failure; D014230:Triazoles / Q000008:administration & dosage / Q000627:therapeutic use*
D000935:Antifungal Agents; D014230:Triazoles; C101425:posaconazole; D064098:Esomeprazole