Activity of posaconazole in the treatment of central nervous system fungal infections

Pitisuttithum, Punnee; Negroni, Ricardo; Graybill, John R.; Bustamante, Beatriz; Pappas, Peter G.; Chapman, Stanley W.; Hare, R S; Hardalo, Catherine

doi:10.1093/jac/dki288

Cited by 226 publications

(127 citation statements)

References 43 publications

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“…Since there is interindividual and intra-individual variability in voriconazole plasma levels, therapeutic drug monitoring for voriconazole should be considered in cases of refractory fungal infection or concerns about drug toxicity [147]. Another broad-spectrum triazole, posaconazole, is effective and safe as salvage therapy in patients with IPA refractory to standard antifungal therapy [22,93,125].…”

Section: Treatmentmentioning

confidence: 99%

“…According to the recent statement of the American Thoracic Society for treating fungal infections in adults [123], the duration of IPA therapy should be individualised to the Continuation therapy: voriconazole or itraconazole [122,123] Salvage therapy: echinocandin or posaconazole [125][126][127] Chronic necrotising aspergillosis Voriconazole [120,123] Alternative therapy: itraconazole [128,129] Severe cases: intravenous voriconazole or liposomal amphotericin B [123,128,130] Consider surgical resection [130] Aspergilloma Observation [123] Bronchial artery embolisation [131] Surgical resection [132][133][134][135] Consider itraconazole [136][137][138] Allergic bronchopulmonary aspergillosis Corticosteroids [139][140][141][142] Itraconazole or voriconazole as steroid-sparing agents [143][144][145][146] Surgical resection has generally a limited role in the management of patients with IPA, but it becomes important in cases with invasion of bone, burn wounds, epidural abscesses and vitreal disease [123]. It should also be considered in cases of massive haemoptysis, pulmonary lesions close to the great blood vessels or pericardium, or residual localised pulmonary lesions in patients with continuing immunosuppression or those who are expected to have immunosuppressive therapy in the future.…”

Section: Treatmentmentioning

confidence: 99%

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Pulmonary aspergillosis: a clinical review

Kousha¹,

Tadi²,

Soubani³

2011

Eur Respir Rev

599

596

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Aspergillus is a mould which may lead to a variety of infectious, allergic diseases depending on the host's immune status or pulmonary structure. Invasive pulmonary aspergillosis occurs primarily in patients with severe immunodeficiency. The significance of this infection has dramatically increased with growing numbers of patients with impaired immune state associated with the management of malignancy, organ transplantation, autoimmune and inflammatory conditions; critically ill patients and those with chronic obstructive pulmonary disease appear to be at an increased risk. The introduction of new noninvasive tests, combined with more effective and better-tolerated antifungal agents, has resulted in lower mortality rates associated with this infection. Chronic necrotising aspergillosis is a locally invasive disease described in patients with chronic lung disease or mild immunodeficiency. Aspergilloma is usually found in patients with previously formed cavities in the lung, whereas allergic bronchopulmonary aspergillosis, a hypersensitivity reaction to Aspergillus antigens, is generally seen in patients with atopy, asthma or cystic fibrosis. This review provides an update on the evolving epidemiology and risk factors of the major manifestations of Aspergillus lung disease and the clinical manifestations that should prompt the clinician to consider these conditions. Current approaches for the diagnosis and management of these syndromes are discussed.

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Section: Treatmentmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Pulmonary aspergillosis: a clinical review

Kousha¹,

Tadi²,

Soubani³

2011

Eur Respir Rev

599

596

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“…ABLC demonstrated a total response of 66% in 101 patients, 75% in 44 cases of first-line therapy (BII) [4]. Posaconazole was effective in 14 from 29 patients [83]; voriconazole data are very limited (CIII). In isolated pulmonary cryptococcosis, fluconazole 200-400 mg for 6-12 months may be sufficient (AIII) [45,95]; alternatively, itraconazole 200-400 mg may be used (BIII).…”

Section: Cryptococcus Neoformans Infectionsmentioning

confidence: 99%

Treatment of invasive fungal infections in cancer patients—Recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO)

Böhme¹,

et al. 2008

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International audienceInvasive fungal infections are a main cause of morbidity and mortality in cancer patients undergoing intensive chemotherapy regimens. Early antifungal treatment is mandatory to improve survival. Today, a number of effective and better-tolerated but more expensive antifungal agents compared to the former gold standard amphotericin B deoxycholate are available. Clinical decision-making must consider results from numerous studies and published guidelines, as well as licensing status and cost pressure. New developments in antifungal prophylaxis improving survival rates result in a continuous need for actualization. The treatment options for invasive infections include fluconazole, voriconazole, and amphotericin B and its lipid formulations, as well as echinocandins. Voriconazole, amphotericin B, amphotericin B lipid formulations, caspofungin, itraconazole, and posaconazole are available for the treatment of invasive aspergillosis. Additional procedures, such as surgical interventions, immunoregulatory therapy, and granulocyte transfusions, have to be considered. The Infectious Diseases Working Party of the German Society of Hematology and Oncology here presents its 2008 recommendations discussing the dos and do-nots, as well as the problems and possible solutions, of evidence criteria selection

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“…This is thought to be due to pharmacokinetics of the drug, combined with host factors. An open label clinical trial of the efficacy of posaconazole in the treatment of patients with CNS fungal infections showed that posaconazole was successful in 48% (14 of 29) of the patients with cryptococcal infection and in 50% (5 of 10) of patients infected with other fungal pathogens [20]. However, posaconazole is not currently approved for this indication [21].…”

Section: Discussionmentioning

confidence: 99%

Cerebral phaeohyphomycosis due to Rhinocladiella mackenziei (formerly Ramichloridium mackenziei): Case presentation and literature review

Al‐Tawfiq

Boukhamseen

2011

Journal of Infection and Public Health

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Summary Rhinocladiella mackenziei (formerly Ramichloridium mackenziei), a causative agent of cerebral phaeohyphomycosis, is extremely rare and it is geographically limited to the Middle East. The organism has a predilection to cause brain infections and results in a grave prognosis with a high mortality rate. The current patient was admitted to a long term care facility with chronic respiratory failure and dependence on a mechanical ventilator. She later developed left sided weakness and a CT-scan of the brain revealed multiple variable sized hypodense, well-defined lesions with ring enhancement. A stereotactic needle aspiration of the largest lesion showed fungal hyphae. The final culture grew R. mackenzie. The patient was initially started on liposomal amphotericin B, then voriconazole and caspofungin intravenously as posaconazole was not available. The patient failed to respond to antifungal therapy and finally she died 34 days after the start of the treatment. R. mackenziei is a highly virulent agent, and should be considered in the differential diagnosis of central nervous system disease in patients from the Middle East.

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Activity of posaconazole in the treatment of central nervous system fungal infections

Abstract: These data suggest that posaconazole, as an oral medication, has clinical activity against fungal infections of the CNS and may provide a valuable alternative to parenteral therapy in patients failing existing antifungal agents.

Cited by 226 publications

References 43 publications

Pulmonary aspergillosis: a clinical review

Pulmonary aspergillosis: a clinical review

Treatment of invasive fungal infections in cancer patients—Recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO)

Cerebral phaeohyphomycosis due to Rhinocladiella mackenziei (formerly Ramichloridium mackenziei): Case presentation and literature review

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