Pharmacokinetic/pharmacodynamic study of posaconazole delayed-release tablet in a patient with coexisting invasive aspergillosis and mucormycosis

Limited information exists regarding the optimal dose of posaconazole delayed-release tablet for the treatment of invasive mold infection. Here, we report the case of a previously healthy 44-year-old Thai man who developed coexisting invasive pulmonary aspergillosis and mucormycosis following a car...

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Bibliographic Details
Published in:Therapeutics and clinical risk management 2019-04, Vol.15, p.589-595
Main Authors: Leelawattanachai, Pannee, Montakantikul, Preecha, Nosoongnoen, Wichit, Chayakulkeeree, Methee
Format: Article
Language:English
Subjects:
Antifungal agents
Aspergillosis
AUC/MIC
Care and treatment
Case Report
Case reports
Drug dosages
Fungal infections
Health aspects
Infection
mixed infection
Mucormycosis
Mycoses
Pharmacodynamics
Pharmacokinetics
Posaconazole
Pulmonary aspergillosis
Therapeutic drug monitoring
Time
Traffic accidents
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Summary:Limited information exists regarding the optimal dose of posaconazole delayed-release tablet for the treatment of invasive mold infection. Here, we report the case of a previously healthy 44-year-old Thai man who developed coexisting invasive pulmonary aspergillosis and mucormycosis following a car accident. He was treated with posaconazole delayed-release tablet. This report describes the pharmacokinetic/pharmacodynamic study, safety profile, and determination of the appropriate dosage of posaconazole delayed-release tablet in a patient with coexisting invasive aspergillosis and mucormycosis. Posaconazole exposure was analyzed by noncompartmental model. Ratio of area under the plasma concentration-time curve over the minimum inhibitory concentration (AUC/MIC) was applied to maximize the efficacy of posaconazole. The loading dose of 300 mg q 12 hrs was found to be potentially insufficient for achieving the AUC/MIC target for treatment of invasive mold infection with minimum inhibitory concentrations >0.01 mg/L. Early therapeutic drug monitoring to detect the drug concentration of posaconazole delayed-release tablet is necessary so that dosing adjustments can be made, as needed. In addition, a maintenance dose of either 400 or 300 mg once daily could achieve the AUC/MIC targets. These maintenance dosing regimens effectuated a successful clinical outcome with minimal adverse events.
ISSN:1176-6336
1178-203X
1178-203X
DOI:10.2147/TCRM.S203625