Impact of structured on-site patient education on low posaconazole plasma concentrations

Ref ID: 19360

Author:

M. Hoenigl, W. Duettmann, B. Huber-Krassnitzer, G. Theiler,
R. B. Raggam, F. Prueller, A. Zebisch, P. Neumeister, J. Wagner,
K. Seeber, A. W€olfler and R. Krause

Author address:

Medical University of Graz, Austria

Full conference title:

6th Trends in Medical Mycology 2013

Date: 11 October 2014

Abstract:

Background Low posaconazole plasma concentrations (PPCs) are
associated with breakthrough invasive mould infections (IMI) among
patients with hematological malignancies. This study evaluates the
influence of a structured personal on-site patient education on in-
sufficient PPCs.
Methods The study was conducted from July 1st 2012 to March
31st 2013 at the Division of Hematology, Medical University of Graz,
Austria. PPCs were measured in all patients with hematological
malignancies receiving the drug prophylactically. The first PPC was
measured 4 days after initiation of posaconazole and then repeated
twice weekly (in case of sufficient PPCs once weekly). Concentrations
above the target of 0.5 mg/L were defined as satisfactory and those
below the target as low PPCs. In patients with low drug levels a
structured personal on-site education concerning the intake of posa-
conazole (e.g intake with fatty and acid food, general importance of
sufficient PPCs) was performed (duration 5-10 minutes).
Results 252 PPCs were measured in 69 patients (23 GVHD phase
after haematopoietic stem cell transplantation, 46 neutropenia after
induction therapy). Initial PPCs were sufficient in 29 (42%) and low
in 40 (58%) patients. 12 of the 40 patients were either discharged or
antifungal therapy was modified before a follow up PPC was obtained.
In the remaining 28 patients a personal on site education was
performed. In 12/28 (42.9%) patients the personal on-site education
led to sufficient levels, while in 16 (57.1%) the PPCs stayed below the
target, although increasing from below 0.1 to above 0.3 in 6 of those
patients. No patient experienced posaconazole side effects and there
was no breakthrough IMI. Three patients died of their underlying
disease in the first six weeks after initiation of posaconazole.
Conclusions In patients with low PPCs a structured personal on site
education led to sufficient levels in more than 40% of patients.
Therefore personal education seems to be a promising tool to
increase low PPCs.

Abstract Number: o2.3

Conference Year: 2013

Link to conference website: NULL

New link: NULL

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