Posaconazole’s impact on prophylaxis and treatment of invasive fungal infections: an update

Abstract

Owing to the morbidity and mortality associated with invasive fungal infections, particularly in the immunocompromised host, development of new agents for both prevention and treatment is essential. Posaconazole is a recently approved extended-spectrum triazole available as an oral suspension. It exhibits fungistatic activity against a variety of fungal pathogens. Pharmacokinetic data in special patient populations (such as neutropenic patients with acute myelogenous leukemia or myelodysplastic syndrome, allogeneic hematopoietic stem cell transplant recipients, febrile neutropenic patients and pediatric patients) have been published recently. Controlled clinical trials establish posaconazole’s safety and efficacy in infections, such as oropharyngeal candidiasis and prophylaxis against invasive fungal infections. Data are also emerging in the treatment of zygomycosis and selected cases of aspergillosis. Posaconazole is well tolerated during short- and long-term use, with the most commonly reported adverse events being mild-to-moderate gastrointestinal disturbances. Data suggest a relationship between posaconazole plasma concentrations and prophylactic efficacy; however, the role of therapeutic drug monitoring has yet to be completely defined. Since posaconazole is available only as an oral formulation, its use may be limited in critically ill patient populations.

Keywords::

• antifungal prophylaxis
• azole
• fungal infection
• posaconazole
• triazole

Financial & competing interests disclosure

Richard Drew is a consultant of Merck, Theravance, Schering-Plough, Forest and Wyeth-Ayerst, and has speaker honoraria with Schering-Plough, Ortho-McNeil, Enzon and Astellas. He has also recieved research support from Schering-Plough, NeuTec and Cubist Development Team (CustomID). John Perfect has research grants, consultant and honoraria with Astellas, Enzon, Merck, Pfizer and Schering-Plough. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.