title: Impact of structured personal on-site patient education on low posaconazole plasma concentrations in patients with haematological malignancies.
abstract: Low posaconazole plasma concentrations (PPCs) are associated with breakthrough invasive mould infections among patients with haematological malignancies. This study evaluated the influence of structured personal on-site patient education on low PPCs. The study was conducted from July 2012 to May 2013 at the Division of Hematology, Medical University Hospital of Graz (Graz, Austria). PPCs were measured in all patients with haematological malignancies receiving the drug prophylactically. Concentrations above the target of 0.5 mg/L were defined as satisfactory and those below this concentration as low. In patients with low PPCs, structured personal on-site education regarding the intake of posaconazole (e.g. intake with fatty/acid food, prevention of nausea and vomiting) was performed. In total, 258 steady-state PPCs were measured in 65 patients [median PPC 0.59 mg/L, interquartile range 0.25-0.92 mg/L; 141/258 (54.7%) satisfactory]. Diarrhoea was the strongest predictor of low PPCs in the multivariate analysis. Initial steady-state PPCs were sufficient in 29 patients and low in 36 patients. Of the 36 patients with low initial steady-state PPCs, 8 were either discharged or antifungal therapy was modified before a follow-up PPC was obtained; in the remaining 28 patients, personal on-site education was performed. In 12/28 patients (43%) the personal on-site education led to sufficient levels, whilst in 16 (57%) PPCs stayed below the target, although increasing from <0.2 mg/L to >0.3 mg/L in 6 of these patients. In conclusion, personal education appears to be a promising tool to increase low PPCs.
authors: Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria; Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria. Electronic address: martin.hoenigl@medunigraz.at.
authors: Martin
authors: M
authors: Hoenigl
authors: Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria; Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
authors: Wiebke
authors: W
authors: Duettmann
authors: Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University Hospital of Graz, Graz, Austria.
authors: Reinhard B
authors: RB
authors: Raggam
authors: Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
authors: Bianca
authors: B
authors: Huber-Krassnitzer
authors: Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
authors: Georg
authors: G
authors: Theiler
authors: Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
authors: Katharina
authors: K
authors: Seeber
authors: Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University Hospital of Graz, Graz, Austria.
authors: Florian
authors: F
authors: Prueller
authors: Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
authors: Ines
authors: I
authors: Zollner-Schwetz
authors: Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
authors: Jürgen
authors: J
authors: Prattes
authors: Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
authors: Jasmin
authors: J
authors: Wagner
authors: Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
authors: Albert
authors: A
authors: Wölfler
authors: Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
authors: Robert
authors: R
authors: Krause
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000493:pharmacokinetics* / Q000627:therapeutic use; D001317:Austria; D018890:Chemoprevention / Q000379:methods*; D015331:Cohort Studies; D016903:Drug Monitoring; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009181:Mycoses / Q000517:prevention & control*; D010353:Patient Education as Topic; D010949:Plasma / Q000737:chemistry*; D014230:Triazoles / Q000493:pharmacokinetics* / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D014230:Triazoles; C101425:posaconazole
keywords: Haematological malignancy; Patient education; Plasma concentrations; Posaconazole; Prophylaxis; Therapeutic drug monitoring