Posaconazole Therapy for Coccidioidomycosis: A Case Series

GREGORY ANSTEAD, MD,TX; GAVIN CORCORAN, MD,DEBORAH BERG, RN,JAMES LEWISJOHN R. GRAYBILL, MD,

Author address: 

Univ. of Texas Health Science Ctr., San Antonio,Schering-Plough Research Institute, Kenilworth

Abstract: 

Objective: Coccidioidomycosis is a fungal infection endemic to the southwestern United States that results from inhalation of Coccidioides immitis arthroconidia. Posaconazole (POS), an investigational broad-spectrum azole antifungal agent, is active against Coccidioides immitis both in vitro and in animal models. This abstract reports the efficacy of POS for the treatment of coccidioidomycosis after standard antifungal therapies failed in a series of six patients. Methods: All patients had proven coccidioidomycosis; sites of infection included lung, bone, joints and skin. POS therapy was initiated after the disease became refractory to, or the patient became intolerant of, antifungal therapy with amphotericin B and/or one or more azoles (fluconazole and itraconazole). POS 800 mg/day was administered as either 200 mg four timesdaily or 400 mg twice-daily. Outcomes were considered a success if a complete or partial clinical response was observed. The maximum duration of dosing in these patients was 13 months. Results: In all six patients, POS therapy resulted in substantial clinical improvements, including resolution of skin/ bony lesions, fevers, night sweats, wasting, and pulmonary abnormalities. In addition, C. immitis titers decreased. In several cases, the patients were critically ill despite 6 weeks of prior antifungal therapy. POS was generally well-tolerated, with five patients receiving 10 months of therapy. Conclusion: The consistent clinical responses observed in these six patients suggest the potential utility of posaconazole for the treatment of life-threatening infections due to C. immiti
2003

abstract No: 

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Full conference title: 

41st Annual Meeting Infectious Diseases Society of America
    • Infectious Diseases Society of America 41st