Treatment of Aspergillus fumigatus infection with posaconazole delayed-release tablets.

Abstract

A pediatric patient with cystic fibrosis (CF) was successfully treated for Aspergillus fumigatus infection with posaconazole delayed-release tablets. A 13-year-old, 29-kg, Caucasian boy with CF was admitted to the hospital for a pulmonary exacerbation. The patient had a history of multiple hospital admissions and was colonized with methicillin-sensitive Staphylococcus aureus, Stenotrophomonas maltophilia, and A. fumigatus. The patient was started on piperacillin-tazobactam 2.8 g (piperacillin 2 g and tazobactam 0.8 g) i.v. every 6 hours (400 mg/kg/day) and tobramycin 400 mg i.v. every 24 hours (13.7 mg/kg/day). After 2 weeks of therapy and therapeutic tobramycin concentrations, doxycycline 75 mg given orally twice daily was continued due to lack of clinical improvement. After 2 additional weeks of therapy, the patient was started on posaconazole delayed-release tablets 300 mg given orally daily with the evening meal due to concern about A. fumigatus colonization and a further decline in forced expiratory volume in 1 second to 37%. The posaconazole trough concentration was 1,500 ng/mL after 5 days of therapy. As this level was within the goal range, posaconazole was continued, with a plan to periodically check the trough level, pulmonary function, and liver function. The patient's liver function values remained stable throughout therapy. The patient's appetite improved and weight increased. Once the patient's weight exceeded 35 kg, his dosage of posaconazole delayed-release tablets was increased to 400 mg daily. His pulmonary function improved during posaconazole therapy, and A. fumigatus was eradicated. Posaconazole was discontinued after 9 months of therapy. A 13-year old patient with CF was successfully treated for an A. fumigatus infection with posaconazole delayed-release tablets.