Publication: A case report of intravenous posaconazole in hepatic and renal impairment patient with invasive Aspergillus terreus infection: safety and role of therapeutic drug monitoring
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2017
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eng
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Mahidol University
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BioMed Central
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BMC Pharmacology and Toxicology. vol.18, No.1 (2017), 8
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Pitchaya Dilokpattanamongkol, Panadda Panusitthikorn, Rasda Boonprasert, Methee Chayakulkeeree, Porpon Rotjanapan A case report of intravenous posaconazole in hepatic and renal impairment patient with invasive Aspergillus terreus infection: safety and role of therapeutic drug monitoring. BMC Pharmacology and Toxicology. vol.18, No.1 (2017), 8. doi:10.1186/s40360-017-0115-z Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/43781
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A case report of intravenous posaconazole in hepatic and renal impairment patient with invasive Aspergillus terreus infection: safety and role of therapeutic drug monitoring
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Mahidol University. Faculty of Pharmacy. Department of Pharmacy
Mahidol University. Faculty of Medicine, Siriraj Hospital. Department of Pharmacy
Mahidol University. Faculty of Medicine, Siriraj Hospital. Clinical Toxicology Laboratory, Siriraj Poison Control Center
Mahidol University. Faculty of Medicine, Siriraj Hospital. Division of Infectious Diseases and Tropical Medicine,
Mahidol University. Department of Medicine, Ramathibodi Hospital. Division of Infectious Diseases
Mahidol University. Faculty of Medicine, Siriraj Hospital. Department of Pharmacy
Mahidol University. Faculty of Medicine, Siriraj Hospital. Clinical Toxicology Laboratory, Siriraj Poison Control Center
Mahidol University. Faculty of Medicine, Siriraj Hospital. Division of Infectious Diseases and Tropical Medicine,
Mahidol University. Department of Medicine, Ramathibodi Hospital. Division of Infectious Diseases
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Background: Invasive aspergillosis (IA) is a fatal infectious complication among immunocompromised patients.
Aspergillus terreus, the fourth common species can be difficult to treat due to a unique resistance pattern. To date,
there has been no report on safety and dose adjustment when intravenous posaconazole is selected in hepatic and
renal impairment patient. We present a rare case of intravenous posaconazole use in a hepatic and renal
impairment patient with invasive A. terreus pulmonary infection. To our knowledge, this is the first report of
intravenous posaconazole use in IA due to A. terreus with hepatic and renal impairment focusing on drug safety
and role of therapeutic drug monitoring (TDM).
Case presentation: A 37-year-old previously healthy man with diagnosis of dengue hemorrhagic fever and shock
complicated with hepatic and renal impairment proposed to have proven invasive A. terreus pulmonary infection is
described. Due to lack of good clinical response and concern of potential adverse effects whilst on intravenous
voriconazole, intravenous posaconazole 300 mg every 48 h was chosen with confirmed therapeutic plasma
concentrations. Despite the death of the patient and IA deemed uncontrollable, there were no significant side
effects attributable to intravenous posaconazole use demonstrated over a period of 34 days.
Conclusions: Intravenous posaconazole use with TDM implementation maybe a safe alternative option to standard
therapy. Therapeutic plasma posaconazole level may be reached at lower dosing regimen in renal and hepatic
impairment patient. However, explanations of clinical failure on this patient with immunodeficiency state were
multifactorial.