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 insufficient 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 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 posaconazole (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.
Full conference title:
53rd Interscience Conference on Antimicrobial Agents and Chemotherapy
- ICAAC, 53rd (2013)