A retrospective observational cohort study from the hospital perspective was conducted using national administrative data from the Premier Perspective™ Database. Patients (n = 1603) coded for infection caused by Aspergillus species during 1835 admissions who received at least 3 days of intravenous antifungal therapy between 2000 and 2006 were
included. All costs were inflated to $US 2006. Length of stay, hospital costs and mortality were compared after stratification by initial antifungal therapy. Median hospital costs were $52 803 this website (25 929–100 730) and did not differ by year over the study period. Intravenous antifungals accounted for 7.2% (range: 0.78–15.9%) of the cost of aspergillosis-related hospitalisation. Crude mortality was 36.7% and was the lowest in the last 2 years of the study (2005, 2006). Although antifungal utilisation changed over the course of the study, initial antifungal choice was not independently associated with crude mortality. In contrast, initial therapy with intravenous voriconazole was associated with reduced total hospitalisation costs and length of hospital stay. Treatment with amphotericin B lipid complex or caspofungin was also independently associated with a reduced length of hospital stay. In this large US study, mortality and costs for aspergillosis-related hospitalisations were considerable,
selleckchem but antifungals accounted for a small percentage of total costs associated with treatment and did not independently affect in-hospital crude mortality. Only initial treatment with intravenous voriconazole was associated with reduced total hospitalisation costs. “
“Posaconazole represents an antifungal extended-spectrum triazole whose absolute bioavailability
following oral drug administration is considerably variable. Special conditions including increased gastric pH values, malabsorption syndrome, diarrhoea, intake on an empty Pregnenolone stomach and some concomitantly administered potent enzyme-inducing drugs may contribute to lower drug plasma levels than expected. As a consequence, establishment of Therapeutic Drug Monitoring (TDM) has been proposed to be beneficial in patients receiving antifungal prophylaxis or therapy with posaconazole. Based on its considerable CYP3A inhibiting potency, posaconazole may significantly increase plasma concentrations of concomitantly applied drugs which undergo an extensive first-pass effect through gut and liver. More intensified posaconazole TDM may help to estimate the extent of drug interaction more accurately. “
“Mucormycoses remain a serious complication in patients undergoing allogeneic haematopoietic stem cell transplantation (HSCT). In these patients, mortality rates of mucormycosis reach up to 90%, which is due, at least in part, to the severe and prolonged immunosuppression after transplantation.