Caspofungin and voriconazole (VCZ) has improved the management of invasive fungal infections (IFIs).University Hospital of Nantes, the combination of these two molecules is off GHS recourse increasingly used in surgical intensive care in thoracic transplant patients. These dual therapy prescribed off repository of good use, were analyzed retrospectively to study the indications and durations.
From 2008 to 2010, patients who received injectable combination VCZ and caspofungin have been identified through the traceability file molecules off-GHS. Clinical and mycological data, dosages used, as well as the therapeutic drug monitoring of VCZ of these patients were analyzed retrospectively.
Twenty treatments were identified. Dual therapy prescribed is pending residue that VCZ> 1 .mu.g / mL (C 0 ) in the IFI framework requiring effective monotherapy VCZ (60% of courses) or to obtain a synergistic antifungal 2 through IFI poor prognosis (40%). The average duration of dual therapy was 16 days (+/- 7d) in the first indication versus 18j (+/- 13j) in the second. The C 0 > 1 .mu.g / ml is reached on average after 7,1j (+/- 6,3j). 2 patients will never reach that target. The C 0 show high variability between and within individual. Dosages of VCZ at equilibrium vary from 2.2 to 9.6 mg / kg / 12h.
This combination therapy showed an additive or synergistic in vitro combination of Aspergillus fumigatus, but the data in human medicine, limited to small cohort studies do not conclude as to its interest. However, the repository of the AFSSAPS does not consider this association as unacceptable. C 0 <1 .mu.g / mL is associated with clinical failure, the use of combination therapy in anticipation of a C 0 > 1 .mu.g / mL in these patients appears to be justified by the time needed to reach this target IV, and then to maintain this rate during the po relay. A multidisciplinary reflection should be conducted to try to guide the combination therapy pending the availability of repositories: frequency of pharmacological doses, dose escalation, changes in the administration schedule ...
Full conference title:
- RICAI 31st (2011)