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Case Reports
. 2019 Apr 24:15:589-595.
doi: 10.2147/TCRM.S203625. eCollection 2019.

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

Pannee Leelawattanachai  1   2 , Preecha Montakantikul  1 , Wichit Nosoongnoen  1 , Methee Chayakulkeeree  3
Affiliations
Case Reports

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

Pannee Leelawattanachai et al. Ther Clin Risk Manag. .

Abstract

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.

Keywords: AUC/MIC; antifungal; invasive fungal infection; mixed infection; therapeutic drug monitoring; treatment.

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Conflict of interest statement

All authors declare no personal or professional conflicts of interest, and no financial support from the companies that produce and/or distribute the drugs, devices, or materials described in this report.

Figures

Figure 1
Figure 1
Posaconazole plasma concentration on days 1, 7, 14, and 35 in a patient with coexisting invasive aspergillosis and mucormycosis.
Figure 2
Figure 2
Chest computed tomography of a patient with invasive pulmonary aspergillosis and mucormycosis. Before the start of posaconazole (A); day 35 after the start of posaconazole treatment (B); and, day 90 after the start of posaconazole treatment (C).
See this image and copyright information in PMC

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