OBJECTIVE Initial posaconazole dosing regimens in children often do not achieve target concentrations, and data continue to support the need for higher initial dosing regimens. The objective of this study is to contribute to the current data regarding suboptimal posaconazole dosing in pediatric patients by retrospectively observing dosing strategies and subsequent drug concentrations. METHODS This study was conducted at a single institution in 27 patients aged 1 to 21 years. Patients who were initiated on any formulation of posaconazole for prophylaxis or treatment while admitted to the hospital were included. The primary outcome was to determine the percentage of pediatric patients who achieved the targeted trough concentration using their initial posaconazole dosing regimen. Secondary outcomes included percentage of patients who experienced a breakthrough invasive fungal infection (IFI), percentage of patients with elevated liver function tests (LFTs), and discontinuation for any reason. RESULTS There were 15 patients (55.5%) who reached desired trough serum concentration after the initial dosing regimen. The number of dose modifications to achieve the desired trough ranged from 1 to 3. Most patients received delayed-release tablets (n = 17), and the average doses for reaching prophylactic and treatment trough concentrations were 6.1 mg/kg/day and 11 mg/kg/day, respectively. There were 2 patients (7.4%) who experienced breakthrough IFI. Overall, 5 patients developed elevated LFTs and 7 patients discontinued treatment early. CONCLUSIONS The results describe a single population of pediatric patients, of whom 55% were able to achieve target trough concentrations of posaconazole with the initial dosing strategy used.
Background: Preventative health services are often underutilized by under-resourced populations. This study aimed to evaluate the utility of a student-run preventative health consultation (PHC) service at free walk-in clinics. Methods: This prospective cohort study recruited adult participants from student-run free walk-in clinics at a Spanish-language church and a homeless shelter. During the PHCs, recommendations from the United States Preventative Services Task Force and Centers for Disease Control and Prevention immunization schedule were discussed with participants. The top three recommendations for each participant were prioritized using shared decision-making. Participants completed a post-PHC survey and were contacted within three months about recommendation completion status. Recommendations were grouped into categories and analyzed using descriptive statistics. Results: Of the 29 people enrolled in the study, 48% (n=14) were Spanish-speaking, and 45% (n=13) were homeless/displaced. There were 87 recommendations made and categorized as health behaviors (29.9%, n=26), vaccinations (18.4%, n=16), chronic disease screenings (18.4%, n=16), communicable disease screenings (17.2%, n=15), cancer screenings (11.5%, n=10), and other (4.6%, n=4). The most common completed recommendations were changes in health behaviors (46.2%, n=12) and chronic disease screenings (37.5%, n=6). Of the participants who completed the post-PHC survey, 96% (n=27) agreed or strongly agreed they learned new information about their health from the PHC, and 100% (n=29) reported being glad to have engaged in the PHC and that the PHC service should continue at the monthly clinics. Conclusions: Health behaviors, vaccinations, and chronic disease screenings were the most frequently prioritized preventative health needs. Student-run PHC services may offer a way to increase underserved patient knowledge and engagement with preventative healthcare.
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