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Experience using intravenous posaconazole in paediatric and young adult oncology patients.
Journal of Antimicrobial Chemotherapy ( IF 5.2 ) Pub Date : 2020-09-14 , DOI: 10.1093/jac/dkaa377
Arathi A Lambrix 1 , Hope D Swanson 2 , Jennifer L Pauley 3 , Allison W Bragg 2 , Delia C Carias 2 , Melissa S Bourque 2 , Yinmei Zhou 4 , Cheng Cheng 4 , William L Greene 2 , Gabriela Maron 5
Affiliation  

Abstract
Background
Posaconazole exhibits broad-spectrum antifungal activity. An IV formulation became available in 2014. Few studies describing the use of this formulation exist in patients under the age of 18 years. This study describes our experience using IV posaconazole in paediatric and young adult cancer patients.
Methods
This single-centre retrospective chart review evaluated patients who received IV posaconazole and had at least one posaconazole plasma concentration obtained after five or more days with a consistent dosage. Relationships between doses required to achieve a plasma concentration of ≥1 µg/mL and patient age, weight and body surface area (BSA) were evaluated. The clinical record was reviewed to identify descriptions of any adverse events.
Results
Twenty-five patients were analysed, with a median age of 10.5 years (range 1.9–22.9 years; 92% were <18 years). All patients were able to achieve a posaconazole plasma concentration ≥1 µg/mL during their treatment course. The daily mg/kg/day dose required to achieve the target concentration decreased significantly with increasing age of the patient (P =0.018). Assessment of dosage based on BSA suggested a requirement of 225 mg/m2/day across all age groups <18 years. Adverse events documented in the clinical record were consistent with those described with the oral formulations. No CNS toxicities were observed with use of IV posaconazole.
Conclusions
Concentrations ≥1 µg/mL are achievable and a BSA-based dosing approach may allow a consistent empirical dose for patients <18 years of age. Therapeutic drug monitoring is recommended to ensure patients achieve therapeutic concentrations.


中文翻译:

在儿科和年轻成人肿瘤患者中使用静脉泊沙康唑的经验。

摘要
背景
泊沙康唑具有广谱抗真菌活性。2014 年推出了一种 IV 制剂。很少有研究描述在 18 岁以下的患者中使用这种制剂。本研究描述了我们在儿科和年轻成人癌症患者中使用静脉注射泊沙康唑的经验。
方法
这项单中心回顾性图表评价评估了接受静脉泊沙康唑并在五天或更长时间后以一致剂量获得至少一种泊沙康唑血浆浓度的患者。评估了达到≥1 µg/mL 血浆浓度所需的剂量与患者年龄、体重和体表面积 (BSA) 之间的关系。审查临床记录以确定任何不良事件的描述。
结果
分析了 25 名患者,中位年龄为 10.5 岁(范围 1.9-22.9 岁;92% 的患者年龄小于 18 岁)。所有患者在治疗过程中都能达到泊沙康唑血浆浓度≥1 µg/mL。达到目标浓度所需的每日 mg/kg/day 剂量随着患者年龄的增加而显着降低(P  = 0.018)。基于 BSA 的剂量评估表明,所有年龄小于 18 岁的年龄组需要 225 mg/m 2 /天。临床记录中记录的不良事件与口服制剂所描述的那些一致。使用 IV 泊沙康唑未观察到 CNS 毒性。
结论
浓度≥1 µg/mL 是可实现的,并且基于 BSA 的给药方法可能允许对 <18 岁的患者进行一致的经验剂量。建议进行治疗药物监测以确保患者达到治疗浓度。
更新日期:2020-11-13
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