title: Posaconazole liquid suspension in solid organ transplant recipients previously treated with voriconazole.
abstract: BACKGROUND
  Posaconazole (PCZ) has become an attractive alternative to voriconazole (VCZ) in transplant recipients with suspected or proven invasive filamentous fungal infections, causing fewer drug interactions. Here, we describe our experience with PCZ after VCZ in solid organ transplant (SOT) recipients.
  
  
  METHODS
  VCZ was replaced by PCZ liquid solution in 19 SOT recipients (15 lung, 2 kidney, 1 liver, and 1 heart/lung) with invasive pulmonary aspergillosis (12/19; 63.2%), possible invasive pulmonary fungal infection (2/19; 10.5%), prophylaxis (2/19; 10.5%), or pulmonary scedosporiosis, mucormycosis, and mixed fungal species (1 each). Rationales for switch were suspected adverse reactions to VCZ (17/19; 89.4%) and desire to broaden spectrum of coverage to include agents of mucormycosis (3/19; 15.8%).
  
  
  RESULTS
  PCZ was well tolerated in all patients. In those patients with baseline liver enzyme abnormalities, a median change occurred in concentrations of alanine transaminase (-20 IU/L), aspartate aminotransferase (-17.5 IU/L), and alkaline phosphatase (-61.5 IU/L). Clinical success (resolution, stabilization, or prevention of infection) was achieved in 16/19 (84%) people.
  
  
  CONCLUSIONS
  PCZ appears to have a reasonable safety and tolerability profile and may be an effective alternative in SOT patients who require an agent with anti-mold activity, but are unable to tolerate VCZ.
authors.affiliation: Transplant and Oncology Infectious Diseases Program, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: S
authors.initials: S
authors.lastname: Shoham
authors.affiliation: Transplant and Oncology Infectious Diseases Program, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: D
authors.initials: D
authors.lastname: Ostrander
authors.affiliation: Transplant and Oncology Infectious Diseases Program, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: K
authors.initials: K
authors.lastname: Marr
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D055744:Invasive Pulmonary Aspergillosis / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009091:Mucormycosis / Q000188:drug therapy; D009181:Mycoses / Q000188:drug therapy*; D066027:Transplant Recipients; D019737:Transplants; D014230:Triazoles / Q000627:therapeutic use*; D065819:Voriconazole / Q000627:therapeutic use
chemical_list: D000935:Antifungal Agents; D014230:Triazoles; C101425:posaconazole; D065819:Voriconazole
keywords: fungal infection prevention; posaconazole; solid organ transplant; voriconazole
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