Treatment of fungal infections in adult pulmonary and critical care patients

Лимпер, Х.; Нокс, С.; Сарози, А.; Ампель, М.; Bennett, Erin; Катанзаро,; Давьес, Ф.; Дисмукс, Е.; Хейг, А.; Marr, Anja; Modi, Kush; Perfekt, Roland; Стивенс, А.

doi:10.18093/0869-0189-2011-0-3-9-52

Cited by 28 publications

(75 citation statements)

References 241 publications

(314 reference statements)

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“…Although the optimal therapeutic regimen and duration of treatment have not been established, long-term oral itraconazole is currently recommended as the primary treatment for CPA (3)(4)(5). CPA usually occurs in middle-aged and elderly patients, for whom the most common underlying disease is pulmonary tuberculosis (6,7).…”

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confidence: 99%

Effect of Rifampin and Rifabutin on Serum Itraconazole Levels in Patients with Chronic Pulmonary Aspergillosis and Coexisting Nontuberculous Mycobacterial Infection

Moon

Park

Jeong

et al. 2015

Antimicrob Agents Chemother

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bWe investigated the effects of rifampin and rifabutin on serum itraconazole levels in patients with chronic pulmonary aspergillosis. Serum itraconazole concentrations were significantly lower in patients who received itraconazole with rifampin (median, 0.1 g/ml; P < 0.001) or rifabutin (median, 0.34 g/ml; P < 0.001) than those receiving itraconazole alone (median, 5.92 g/ml). Concomitant use of rifampin or rifabutin and itraconazole should be avoided in patients with chronic pulmonary aspergillosis and coexisting mycobacterial infections. Chronic pulmonary aspergillosis (CPA) is a slowly progressive pulmonary infectious disease secondary to local invasion by a species of Aspergillus, usually Aspergillus fumigatus (1, 2). Although the optimal therapeutic regimen and duration of treatment have not been established, long-term oral itraconazole is currently recommended as the primary treatment for CPA (3-5). CPA usually occurs in middle-aged and elderly patients, for whom the most common underlying disease is pulmonary tuberculosis (6, 7). In addition, there is increasing evidence that nontuberculous mycobacterial (NTM) lung disease is an important underlying condition associated with CPA (7-12), with some patients having CPA and coexisting NTM lung disease (12,13).Mycobacterium avium complex (MAC) is the most common etiology of NTM lung disease (14-16). Rifampin is recommended as part of a multidrug antibiotic regimen for the treatment of MAC lung disease (14-16). Rifampin is a potent inducer of hepatic cytochrome P450 enzymes, which in turn can accelerate the hepatic metabolism of antifungal agents. In this way, rifampin presents a practical challenge for choosing the appropriate antibiotics for treating CPA with coexisting NTM lung disease (17,18). Indeed, previous case reports have demonstrated that concurrent administration of rifampin with itraconazole can greatly reduce serum itraconazole concentrations (19)(20)(21)(22).Rifabutin has less severe drug-drug interactions than does rifampin and is used as a substitute for rifampin in the treatment of tuberculosis and NTM lung disease, especially for patients who are receiving medications that have unacceptable interactions with rifampin, such as antiretroviral agents (14, 23). Nevertheless, there are no published studies that evaluated the interaction between rifabutin and itraconazole. Thus, the objective of the present study was to investigate the effects of rifampin and rifabutin on serum itraconazole levels in patients with CPA and coexisting mycobacterial lung disease.This study was a single-institution retrospective review of 66 patients with CPA who were treated with oral itraconazole (Sporanox, Janssen Pharmaceutica) (200 mg twice daily) and for whom serum itraconazole concentrations were measured between January 2013 and June 2014. Peripheral venous sampling was performed prior to morning itraconazole administration to determine trough concentrations after at least 7 days of treatment.The serum concentrations of itraconazole and hydroxyl-itraconazole we...

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confidence: 99%

Effect of Rifampin and Rifabutin on Serum Itraconazole Levels in Patients with Chronic Pulmonary Aspergillosis and Coexisting Nontuberculous Mycobacterial Infection

Moon

Park

Jeong

et al. 2015

Antimicrob Agents Chemother

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“…Aspergillus species are the most common cause of mortality due to invasive mycoses in the United States (9). More than 300 species of Aspergillus have been identified, although only 19 species have been described to cause disease in humans.…”

Section: Discussionmentioning

confidence: 99%

Bronchomediastinal Fistula Caused by Endobronchial Aspergilloma

et al. 2015

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“…Histoplasmosis, infection with H. capsulatum, is typically asymptomatic but can be a significant source of morbidity in HIV-infected people and individuals undergoing tumor necrosis factor (TNF) agonist therapy (6); individuals with underlying lung disease, including emphysema, are also at risk (5). Histoplasmosis can mimic a variety of conditions and should be considered in patients with the appropriate geographic exposure and risk factors.…”

Section: Fungal Pneumonia Guidelines: the Outcome And The Processmentioning

confidence: 99%

“…Like histoplasmosis, most Coccidioides infections are asymptomatic, and the most susceptible populations include immunosuppressed individuals, including individuals receiving solid organ transplants (5,7). Because coccidiomycosis can resemble CAP, geographic location and travel history are important considerations in making the correct diagnosis.…”

Section: Fungal Pneumonia Guidelines: the Outcome And The Processmentioning

confidence: 99%

“…Infection with mucormycosis (including Rhizopus, Mucor, Rhizomucor, and Cunninghamella) has become an increasingly important source of infection for immunocompromised individuals (5,8,9). Among the populations most susceptible include individuals with diabetic ketoacidosis, HIV infection, solid organ transplant, and hematologic disorders with profound neutropenia (5,8,9).…”

Section: Fungal Pneumonia Guidelines: the Outcome And The Processmentioning

confidence: 99%

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Pneumonia. Treatment and Diagnosis

Mattila¹,

Fine

Limper

et al. 2014

Annals ATS

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Pneumonia remains a leading cause of morbidity and mortality despite advances in treatment and therapy. The "Pneumonia: Treatment and Diagnosis" session of the Pittsburgh International Lung Conference examined topics related to improving care of patients with pneumonia. These topics included the process and quality of care for community-acquired pneumonia (CAP), diagnosis and treatment of emerging fungal pathogens, an overview of the strengths and weaknesses of different diagnostic modalities, and an example of how basic science is exploring immunomodulatory strategies for pneumonia treatment. Systematic health care provider and institutional improvements can decrease mortality rates in CAP, particularly in patients with increasingly complex comorbidities. Aspects of current guidelines for the diagnosis and treatment of fungal pneumonia were reviewed through a series of case presentations. Proper treatment of pneumonia hinges on correct pathogen identification but is complicated by the variety of diagnostic assays with variable specificity, sensitivity, and interpretation. In addressing this topic, Dr. Patrick Murray, Ph.D., discussed a range of diagnostic tests for a variety of pathogens and guidelines for their use. In addition to the current state of CAP treatment, Bill (Beibei) Chen, M.D., Ph.D., presented a new potential therapeutic agent called forsythin, an immunomodulatory compound derived from a plant used in traditional Chinese medicine. These topics, ranging from institution-sized policy to interactions at the molecular scale, paint a broad perspective of the efforts against pneumonia.

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Treatment of fungal infections in adult pulmonary and critical care patients

Cited by 28 publications

References 241 publications

Effect of Rifampin and Rifabutin on Serum Itraconazole Levels in Patients with Chronic Pulmonary Aspergillosis and Coexisting Nontuberculous Mycobacterial Infection

Effect of Rifampin and Rifabutin on Serum Itraconazole Levels in Patients with Chronic Pulmonary Aspergillosis and Coexisting Nontuberculous Mycobacterial Infection

Bronchomediastinal Fistula Caused by Endobronchial Aspergilloma

Pneumonia. Treatment and Diagnosis

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