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Infection-Associated Ocular Cranial Nerve Palsies
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Hardeep Singh Malhotra, Imran Rizvi, Neeraj Kumar, Kiran Preet Malhotra, Gaurav Kumar, Manoj K. Goyal, Manish Modi, Ravindra Kumar Garg, Vivek Lal
Combined surgical debridement, diagnostic, or debulking in nature, with antifungal therapy should be considered for treatment. Amphotericin-B (AmB, conventional type) is the only consistently effective agent in mucormycosis (1.5 mg/kg/day). Liposomal and lipid complex preparations are considered superior, less toxic, and allow for a higher dose (up to 10 mg/kg/day). Other drugs which can be used in patients intolerant to AmB are posaconazole, isavuconazole, and echinocandins (salvage therapy). Oral posaconazole is recommended (600 mg on day 1 followed by 300 mg once a day) as a step-down therapy. For better outcomes, early institution of anti-fungal therapy (started within a week) is recommended. A discernable clinical benefit may take several weeks; the duration of therapy, thus, needs to be individualized.
Anti-Infective Agents
Published in Radhwan Nidal Al-Zidan, Drugs in Pregnancy, 2020
Risk Summary: The use of Posaconazole is better to be avoided in pregnant women, especially during the 1st Trimester, because the pregnancy experience in humans is limited and the reproduction studies in animals have shown low risk.
History of antifungals
Published in Mahmoud A. Ghannoum, John R. Perfect, Antifungal Therapy, 2019
Emily L. Larkin, Ali Abdul Lattif Ali, Kim Swindell
Posaconazole, a hydroxylated analogue of itraconazole, was developed by the Schering-Plough Research Institute and approved for use in 2006 [64]. Posaconazole is effective against opportunistic and endemic fungi, such as Aspergillus spp., Zygomycetes, and Candida species [64,65]. Posaconazole has been shown to be superior to amphotericin B, fluconazole, and itraconazole against most common fungal pathogens in in vitro and animal studies [66]. It is approved for prophylaxis of invasive fungal infections (aspergillosis and candidiasis) in immunocompromised patients and for the treatment of oropharyngeal candidiasis. Recently, a delayed-release formula was created that allows patients to be dosed once to twice daily in the hospital or at home [67].
Evaluating posaconazole, its pharmacology, efficacy and safety for the prophylaxis and treatment of fungal infections
Published in Expert Opinion on Pharmacotherapy, 2022
Paraskevi Panagopoulou, Emmanuel Roilides
Posaconazole has obtained an important position in the antifungal drug armamentarium. Having activity against both yeasts and filamentous fungi beyond Aspergillus spp., it can serve as a broad-spectrum antifungal agent for prophylaxis and empiric therapy. Indeed, its oral formulation is ideal for long-term treatment of patients with susceptible fungi including molds. In particular, its activity against Mucorales makes it an important adjunct to antifungal therapy in invasive mucormycosis. The delayed-release tablet formulation that was developed and studied more recently has been an advantage in the long-term prophylactic administration as it has better bioavailability characteristics than the previously existing oral solution. Posaconazole has been proved to be an excellent oral agent for prophylaxis of invasive fungal diseases especially of those caused by filamentous fungi.
Azole resistance in Aspergillus species: promising therapeutic options
Published in Expert Opinion on Pharmacotherapy, 2021
Shirisha Pasula, Pranatharthi H. Chandrasekar
Aspergillus fumigatus can cause a wide variety of pulmonary fungal diseases, including hypersensitivity pneumonitis, acute invasive aspergillosis (IA), chronic pulmonary aspergillosis (CPA), and allergic bronchopulmonary aspergillosis (ABPA) [1]. The triazoles, itraconazole, isavuconazole, posaconazole, and voriconazole are antifungal agents with potent activity against A. fumigatus. Itraconazole and voriconazole are the preferred agents in patients with chronic pulmonary aspergillosis. Voriconazole and isavuconazole have been studied as first-line agents for the treatment of invasive aspergillosis. Posaconazole is mainly used for prophylaxis against invasive fungal infections in patients with hematological diseases [2–4]. There is an increasing global concern for azole resistance creating difficulty in choosing reliable effective antifungal regimen and is associated with increased mortality. This paper reviews epidemiology, mechanisms and detection of azole resistance, and therapeutic options for azole-resistant Aspergillus infections.
Management of fever and neutropenia in the adult patient with acute myeloid leukemia
Published in Expert Review of Anti-infective Therapy, 2021
Andrew M. Peseski, Mitchell McClean, Steven D. Green, Cole Beeler, Heiko Konig
An alternative option to azole-based antifungal prophylaxis is represented by echinocandins. Echinocandins are antifungal agents with activity against both Candida and Aspergillus [50–52]. Initial investigations into the efficacy and safety profile of echinocandins as prophylaxis in hematologic malignancies were demonstrated in patients undergoing induction chemotherapy [53]. In an open-label, randomized study including 192 patients, Mattiuzzi et al. demonstrated similar efficacy and adverse event rates between caspofungin and itraconazole ([CI, 0.42% to 0.62%]; p = 0.92) [53]. Despite promising results, the conclusions derived from the small sample size required confirmation in the context of larger-scale studies. In a meta-analysis performed by Lee et al. comparing azoles and echinocandins, no difference in mortality was found. Posaconazole, however, was found to be more effective in preventing invasive fungal infections (relative risk of 0.19; [CI, 0.11 to 0.36]) [42]. A meta-analysis performed by Wang et al. further investigated the efficacy and safety profile of echinocandins against azoles for prophylaxis and treatment in neutropenic patients [54]. In patients with hematologic malignancies, echinocandins had higher success rate of prophylaxis compared to azoles (relative risk of 1.08; [CI, 1.02–1.15]) [54]. More recent studies looking into the use of micafungin against azole therapies demonstrated similar effectiveness in prevention of invasive fungal infections [55,56]. However, due to lack of oral preparations, echinocandins are used less frequently for prophylaxis.