Medicina · 2024
[Therapeutic monitoring of itraconazole in patients with chronic pulmonary aspergillosis: a possible solution to a frequent problem].
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Capaccioli Florencia, Messina Fernando, Santiso Gabriela, Marin Emmanuel, Romero Mercedes, Höcht Christian, Opezzo Javier, Bertera Facundo
Аннотация
INTRODUCTION: Chronic pulmonary aspergillosis is a fungal disease that, without specific treatment, generates a slow and progressive destruction of the lung parenchyma. The recommended pharmacological therapy is long-term oral antifungal administration. The efficacy of the treatment (especially with itraconazole) is around 65% and the frequency of recurrences 10-15%. One of the causes could be a deficient plasma level of itraconazole. The objective was to implement therapeutic monitoring (TM) of itraconazole using a sensitive, precise, rapid and reproducible method. Then, based to the results obtained, take a therapeutic approach.
MATERIALS AND METHODS: Two venous blood samples of approximately 2 ml were obtained from each patient, which were analyzed by liquid chromatography (HPLC).
RESULTS: Samples were taken from 36 patients and mycological, antibody and MT of itraconazole studies were performed. A total of 10 patients (27.8 %) showed levels outside the therapeutic range.
DISCUSSION: The TM of itraconazole is a useful tool to improve the effectiveness of chronic pulmonary aspergillosis treatment, the prognosis of the pathology and reduce the percentage of recurrences. The developed method is fast, precise and reproducible, for this reason it can be very useful to be applied in the public hospital setting, where there is precisely no similar one, and thus modify therapeutic behaviors in order to optimize treatments.
MATERIALS AND METHODS: Two venous blood samples of approximately 2 ml were obtained from each patient, which were analyzed by liquid chromatography (HPLC).
RESULTS: Samples were taken from 36 patients and mycological, antibody and MT of itraconazole studies were performed. A total of 10 patients (27.8 %) showed levels outside the therapeutic range.
DISCUSSION: The TM of itraconazole is a useful tool to improve the effectiveness of chronic pulmonary aspergillosis treatment, the prognosis of the pathology and reduce the percentage of recurrences. The developed method is fast, precise and reproducible, for this reason it can be very useful to be applied in the public hospital setting, where there is precisely no similar one, and thus modify therapeutic behaviors in order to optimize treatments.