title: Posaconazole in lung transplant recipients: use, tolerability, and efficacy.
abstract: BACKGROUND
  Fungal infection is a common cause of mortality and morbidity in lung transplant recipients (LuTR). Treatment failure to first-line antifungals because of resistance or intolerance is an increasing problem. Posaconazole (PCZ), a triazole antifungal, is an attractive treatment option.
  
  
  METHODS
  We performed a single-center retrospective study to describe the use, tolerability, efficacy, and drug interaction effect (with tacrolimus) of PCZ oral suspension in LuTR.
  
  
  RESULTS
  Seventy-eight patients were treated with PCZ oral suspension for prophylaxis (n = 15), pre-emptive treatment (n = 31), and treatment of possible (n = 7) and probable (n = 25) invasive fungal infection. A range of fungal isolates was encountered. Resolution was observed in 52.4% (probable, possible, and pre-emptive treatment groups). Aggregate all-cause 1-year mortality was 12.8%. PCZ was well tolerated with 11.5% of patients experiencing adverse effects. Despite dose adjustment strategies, 11.7% of patients experienced supratherapeutic tacrolimus levels, which in 5 cases was associated with a rise (mean 21.6 μmol/L) in serum creatinine.
  
  
  CONCLUSIONS
  PCZ is well tolerated and appears effective in the management of fungal infection after lung transplantation. Patients receiving concurrent tacrolimus require careful therapeutic drug monitoring.
authors.affiliation: Toowoomba Base Hospital, Toowoomba, Queensland, Australia.
authors.forename: C L
authors.initials: CL
authors.lastname: Robinson
authors.affiliation: School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Chau
authors.affiliation: School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.|Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, Queensland, Australia.
authors.forename: S T
authors.initials: ST
authors.lastname: Yerkovich
authors.affiliation: Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, Queensland, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Azzopardi
authors.affiliation: School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.|Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, Queensland, Australia.
authors.forename: P
authors.initials: P
authors.lastname: Hopkins
authors.affiliation: School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.|Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, Queensland, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Chambers
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use*; D004347:Drug Interactions; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000493:pharmacokinetics / Q000627:therapeutic use*; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy*; D016559:Tacrolimus / Q000097:blood / Q000493:pharmacokinetics / Q000627:therapeutic use; D014230:Triazoles / Q000008:administration & dosage / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D007166:Immunosuppressive Agents; D014230:Triazoles; C101425:posaconazole; D016559:Tacrolimus
keywords: fungal infection; lung transplant; posaconazole; tacrolimus interaction