Role of posaconazole in the management of oropharyngeal and esophageal candidiasis

Figures & data

Table 1 Antifungals for the treatment of oropharyngeal candidiasis

Antifungal agent	Form	Strength	Use
Topical
Nystatin	Pastille	200,000 units	Dissolve 1-2 pastilles qid
Nystatin	Suspension	100,000 units	5 mL swish and swallow qid
Clotrimazole	Oral troche	10 mg	Dissolve 1 troche 5 times/day
Amphotericin B	Suspension	1 mg/mL	1 mL swish and swallow qid
Amphotericin B	Lozenge	100 mg	qid
Amphotericin B	Tablet	10 mg	qid
Systemic
Ketoconazole	Tablet	200 mg	1-2 tablets qd-bid
Fluconazole	Tablet	100 mg	1 tablet qd
Fluconazole	Solution	10 mg/mL	10 ml qd
Itraconazole	Capsule	100 mg	200 mg qd
Itraconazole	Solution	10 mg/mL	10-20 ml qd-bid
Posaconazole	Suspension	100 mg/2.5 mL	100 mg qd

Derived from data of Vazquez and Sobel (2003)

Notes: qid, four times daily; tid, three times daily; bid, twice daily; qd, once daily

Table 2 Antifungals for the treatment of esophageal candidiasis

Antifungal Agent	Form	Strength	Use
Ketoconazole	Tablet	200 mg	1–2 tablets qd-bid
Fluconazole	Tablet	100 mg	1 tablet qd
Fluconazole	Solution	10 mg/ml	10ml qd
Itraconazole	Capsule	100 mg	200 mg qd
Itraconazole	Solution	10 mg/ml	10–20 mL qd-bid
Voriconazole	tablet	200 mg	1 tablet bid

Derived from data of Vazquez and Sobel (2003)

Notes: bid, twice daily; qd, once daily

Figure 1 Structure of posaconazole.

Table 3 In vitro susceptibilities of Candida spp. to posaconazole, fluconazole, and itraconazole

		Posaconazole			Fluconazole			Itraconazole
Organism	Range	50%	90%	Range	50%	90%	Range	50%	90%
C. albicans	≤0.004-16	0.003	0.06	0.12– >64	0.25	0.5	<0.004–16	0.003	0.12
C. glabrata	0.3– >4	0.5	2.0	0.25– >64	16	>64	0.03– >4	1	8
C. parapsilosis	0.03–0.12	0.12	0.12	0.12–2.0	0.5	1	0.015–0.25	0.12	0.12
C. tropicalis	0.03– > 4	0.12	0.12	0.12– >64	0.5	2.0	0.015– >4	0.12	0.5
C. krusei	0.03–0.5	0.5	0.5	8– >64	32	>64	0.12–2	0.5	0.5
C. dublinieusis	0.015–0.25	0.30	0.06	0.12– >64	0.12	0.5	0.015–0.5	0.06	0.25
C. lusitaniae	0.015–0.12	0.12	0.12	0.12–8	1	2	0.03–0.5	0.12	0.5

Table 4 Pharmacokinetics of posaconazole

Variable	Value
Volume of distribution (L)	1774
Protein binding (%)	>98
Elimination	Via feces (77%)
	Via urine (1%)
Half-life (hours)	35 (20–66)
Metabolism	Biotranformation via UDG pathway

Derived from data of Herbrecht (2004).

Abbreviations: UDG, uridine diphosphate – glucoronosyltransferase

VazquezJASobelJDDismukesWEPappasPGSobelJDCandidiasisClinical Mycology20031New York, NYOxford University Press14387

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