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. 2022 Mar;47(3):383-385.
doi: 10.1111/jcpt.13518. Epub 2021 Aug 25.

Suboptimal plasma concentrations with posaconazole suspension as prophylaxis in critically ill COVID-19 patients at risk of Covid-associated pulmonary aspergillosis

Paola Mian  1 , Ronald J Trof  2 , Albertus Beishuizen  2 , Joost B Masselink  1 , Alexander D Cornet  2 , Esther T Sportel  1
Affiliations

Suboptimal plasma concentrations with posaconazole suspension as prophylaxis in critically ill COVID-19 patients at risk of Covid-associated pulmonary aspergillosis

Paola Mian et al. J Clin Pharm Ther. 2022 Mar.

Abstract

What is known and objective: The safety and efficacy of different antifungal agents in the prophylaxis of invasive fungal infection in patients with haematological disorders are known. We comment on the poor bioavailability of posaconazole suspension to suggest that it is not useful in critically ill COVID patients.

Comment: The increased mortality and high incidence of COVID-associated pulmonary aspergillosis (CAPA) might justify administration of off-label posaconazole for preventing CAPA, being the only drug officially registered for prophylaxis of fungal infections. We decided to initiate off-label posaconazole prophylaxis in COVID-19 patients, who were mechanically ventilated and exposed to high-dose steroids for progressive pulmonary disease or ARDS. We found that posaconazole suspension was inadequate. Very low trough levels were observed after administration, and the dose adjustments necessary for the therapeutic drug monitoring (TDM) of the drug in our critically ill ICU patients were not useful.

What is new and conclusion: Posaconazole suspension should not be used to prevent CAPA in COVID-19 patients on high-dose steroid therapy.

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Conflict of interest statement

The authors do not declare any conflict of interest.

References

    1. Leonart LP, Tonin FS, Ferreira VL, et al. A network meta‐analysis of primary prophylaxis for invasive fungal infection in haematological patients. J Clin Pharm Ther. 2017;42(5):530‐538. - PubMed
    1. EMA . Noxafil 2020. [updated 09/20/2020]. 2020. Available from: https://www.EMA.europa.eu/en/medicines/human/EPAR/noxafil. Accessed 4th April, 2021.
    1. Ullmann AJ, Lipton JH, Vesole DH, et al. Posaconazole or fluconazole for prophylaxis in severe graft‐versus‐host disease. N Engl J Med. 2007;356(4):335‐347. - PubMed
    1. Cornely OA, Maertens J, Winston DJ, et al. Posaconazole vs. fluconazole or itraconazole prophylaxis in patients with neutropenia. N Engl J Med. 2007;356(4):348‐359. - PubMed
    1. White PL, Dhillon R, Cordey A, et al. A national strategy to diagnose COVID‐19 associated invasive fungal disease in the ICU. Clin Infect Dis. 2020. - PMC - PubMed