title: Posaconazole salvage treatment for invasive fungal infection.
abstract: Invasive fungal infection (IFI) is an important cause of morbidity and mortality. Posaconazole is a second generation triazole with a broad spectrum, and it may be suitable for salvage antifungal treatment although posaconazole is not usually considered to be as first-line antifungal therapy for IFI. The purpose of this study was to assess the utility of posaconazole salvage treatment for IFI. We conducted a retrospective review of patients with salvage antifungal treatment with posaconazole for IFI at our institution between December 2007 and July 2012. A total of ten patients received posaconazole salvage IFI. Etiology of IFI was consisting of mucormycosis (four patients), Paecilomyces variotii (one patient), and unspecified IFI etiology (five patients). Causes of posaconazole treatment were following; intolerance of previous antifungal therapy in five patients, refractory IFI on previous antifungal therapy in four patients, and both intolerance of previous antifungal therapy and refractory IFI on previous antifungal therapy in one patient. Duration of posaconazole salvage treatment ranged from 15 to 355 days with median 47 days. The overall successful posaconazole salvage treatment response rate was 80.0 % (8 of 10 patients). There were three patients who died during the study period. However, only one death was attributed to the progression of IFI. Two patients discontinued posaconazole due to adverse events. Posaconazole salvage treatment was effective antifungal therapy for IFI. Further studies are needed to define the optimal therapeutic strategy.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, University of Utah, SOM 4B319 30 N 1900 E, Salt Lake City, UT, 84132, USA, smonti1976@hotmail.com.
authors.forename: Jong Hun
authors.initials: JH
authors.lastname: Kim
authors.forename: Kali
authors.initials: K
authors.lastname: Williams
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D055323:Byssochlamys / Q000302:isolation & purification; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009089:Mucor / Q000302:isolation & purification; D009181:Mycoses / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014230:Triazoles / Q000627:therapeutic use*; D028761:Withholding Treatment
chemical_list: D000935:Antifungal Agents; D014230:Triazoles; C101425:posaconazole
references.citation: Antimicrob Agents Chemother. 2012 Nov;56(11):5503-10
references.pmid: 22890761
references.citation: Clin Infect Dis. 2002 Apr 1;34(7):909-17
references.pmid: 11880955
references.citation: Mycoses. 2013 May;56(3):304-10
references.pmid: 23170837
references.citation: Clin Infect Dis. 2006 Jun 15;42(12):1726-34
references.pmid: 16705579
references.citation: Transpl Infect Dis. 2007 Jun;9(2):89-96
references.pmid: 17461992
references.citation: J Infect Dis. 2005 Apr 15;191(8):1350-60
references.pmid: 15776383
references.citation: Clin Infect Dis. 2006 Apr 1;42(7):e61-5
references.pmid: 16511748
references.citation: Transplantation. 2008 Sep 27;86(6):791-6
references.pmid: 18813103
references.citation: Blood. 2011 Aug 4;118(5):1216-24
references.pmid: 21622653
references.citation: Haematologica. 2001 Aug;86(8):862-70
references.pmid: 11522544
references.citation: Clin Infect Dis. 2007 Jan 1;44(1):2-12
references.pmid: 17143808
references.citation: Leukemia. 2008 Mar;22(3):496-503
references.pmid: 18094720
references.citation: Clin Epidemiol. 2011;3:175-91
references.pmid: 21750627
references.citation: Emerg Infect Dis. 2009 Sep;15(9):1395-401
references.pmid: 19788806
references.citation: Transpl Infect Dis. 1999 Dec;1(4):229-36
references.pmid: 11428994
references.citation: Antimicrob Agents Chemother. 2006 Jun;50(6):2009-15
references.pmid: 16723559
references.citation: Clin Infect Dis. 2008 Sep 1;47(5):674-83
references.pmid: 18637757
references.citation: Diabetes Res Clin Pract. 2010 Jan;87(1):4-14
references.pmid: 19896746
references.citation: Infect Dis Clin North Am. 2013 Jun;27(2):305-16
references.pmid: 23714342
references.citation: Clin Infect Dis. 2005 Feb 15;40(4):e35-7
references.pmid: 15712069
references.citation: Clin Infect Dis. 2008 Jun 15;46(12):1813-21
references.pmid: 18462102
references.citation: Yonsei Med J. 2013 Sep;54(5):1234-40
references.pmid: 23918575
references.citation: Future Microbiol. 2012 Feb;7(2):201-9
references.pmid: 22324990