title: Clinical effectiveness of early posaconazole suspension pre-emptive therapy in lung transplant recipients: The Alfred's experience.
abstract: This study describes the clinical outcomes and therapeutic drug monitoring (TDM) following posaconazole suspension pre-emptive therapy in lung transplant (LTx) recipients.
  
  
  
  This was a single-centre, retrospective cohort study evaluating posaconazole suspension pre-emptive therapy in LTx recipients between January 2009 and December 2015.
  
  
  
  Forty-two LTx recipients were prescribed posaconazole suspension pre-emptively. Aspergillus fumigatus was the most commonly isolated fungal organism. Of the patients receiving posaconazole suspension as the initial antifungal post-LTx, 93% had eradication of colonization at 6 months after commencing therapy. In contrast, only 61% had eradication of fungal colonization when posaconazole suspension was administered following initial therapy with voriconazole. Posaconazole suspension appeared to be well tolerated, although one case was curtailed following concern about abnormal liver function and another due to nausea/vomiting. TDM was performed in 37 patients. The initial median (IQR) trough plasma concentration ( C min ) following 400 mg twice-daily posaconazole suspension was 0.78 (0.46-1.19) mg/L. Doses beyond 800 mg daily did not appear to result in a higher median C min.
  
  
  
  Early initiation of posaconazole suspension pre-emptive therapy in LTx recipients appears to be well tolerated and may potentially afford favourable clinical outcomes.
authors.affiliation: Centre for Medicine Use and Safety, Monash University, VIC, Australia.
authors.forename: Wirawan
authors.initials: W
authors.lastname: Jeong
authors.affiliation: Lung Transplant Service, Alfred Health & Monash University, VIC, Australia.
authors.forename: Greg I
authors.initials: GI
authors.lastname: Snell
authors.affiliation: Lung Transplant Service, Alfred Health & Monash University, VIC, Australia.
authors.forename: Bronwyn J
authors.initials: BJ
authors.lastname: Levvey
authors.affiliation: Lung Transplant Service, Alfred Health & Monash University, VIC, Australia.
authors.forename: Glen P
authors.initials: GP
authors.lastname: Westall
authors.affiliation: Department of Infectious Diseases, Alfred Health & Monash University, VIC, Australia.
authors.forename: C Orla
authors.initials: CO
authors.lastname: Morrissey
authors.affiliation: Pharmacy Department, Alfred Health, VIC, Australia.
authors.forename: Steven
authors.initials: S
authors.lastname: Ivulich
authors.affiliation: Collaborative Drug Discovery Research (CDDR) Group Faculty of Pharmacy, Universiti Teknologi MARA, Selangor, Malaysia.
authors.forename: Chin Fen
authors.initials: CF
authors.lastname: Neoh
authors.affiliation: Department of Infectious Diseases, Peter MacCallum Cancer Centre, VIC, Australia.|Victorian Infectious Diseases Service, Royal Melbourne Hospital, VIC, Australia.
authors.forename: Monica A
authors.initials: MA
authors.lastname: Slavin
authors.affiliation: Centre for Medicine Use and Safety, Monash University, VIC, Australia.|Pharmacy Department, Ballarat Health Services, VIC, Australia.
authors.forename: David C M
authors.initials: DCM
authors.lastname: Kong
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000097:blood* / Q000627:therapeutic use; D001228:Aspergillosis / Q000188:drug therapy* / Q000382:microbiology; D001232:Aspergillus fumigatus / Q000187:drug effects* / Q000302:isolation & purification; D015331:Cohort Studies; D016903:Drug Monitoring; D005260:Female; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013535:Suspensions; D066027:Transplant Recipients; D016896:Treatment Outcome; D014230:Triazoles / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood* / Q000627:therapeutic use; D065819:Voriconazole / Q000627:therapeutic use
chemical_list: D000935:Antifungal Agents; D013535:Suspensions; D014230:Triazoles; C101425:posaconazole; D065819:Voriconazole