Browsing by Subject "antifungal"
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Item Open Access Population Pharmacodynamics of Amphotericin B Deoxycholate for Disseminated Infection Caused by Talaromyces marneffei.(Antimicrobial Agents and Chemotherapy, 2019-02) Le, Thuy; Ly, Vo Trieu; Thu, Nguyen Thi Mai; Nguyen, Ashley; Thanh, Nguyen Tat; Chau, Nguyen Van Vinh; Thwaites, Guy; Perfect, John; Kolamunnage-Dona, Ruwanthi; Hope, WilliamAmphotericin B deoxycholate (DAmB) is a first-line agent for the initial treatment of talaromycosis. However, little is known about the population pharmacokinetics and pharmacodynamics of DAmB for talaromycosis. Pharmacokinetic data were obtained from 78 patients; among them, 55 patients had serial fungal CFU counts in blood also available for analysis. A population pharmacokinetic-pharmacodynamic model was fitted to the data. The relationships between the area under the concentration-time curve (AUC)/MIC and the time to blood culture sterilization and the time to death were investigated. There was only modest pharmacokinetic variability in the average AUC, with a mean ± standard deviation of 11.51 ± 3.39 mg·h/liter. The maximal rate of drug-induced kill was 0.133 log10 CFU/ml/h, and the plasma concentration of the DAmB that induced the half-maximal rate of kill was 0.02 mg/liter. Fifty percent of patients sterilized their bloodstreams by 83.16 h (range, 13 to 264 h). A higher initial fungal burden was associated with a longer time to sterilization (hazard ratio [HR], 0.51; 95% confidence interval [CI], 0.36 to 0.70; P < 0.001). There was a weak relationship between AUC/MIC and the time to sterilization, although this did not reach statistical significance (HR, 1.03; 95% CI, 1.00 to 1.06, P = 0.091). Furthermore, there was no relationship between the AUC/MIC and time to death (HR, 0.97; 95% CI, 0.88 to 1.08; P = 0.607) or early fungicidal activity {slope = log[(0.500 - 0.003·(AUC/MIC)]; P = 0.319} adjusted for the initial fungal burden. The population pharmacokinetics of DAmB are surprisingly consistent. The time to sterilization of the bloodstream may be a useful pharmacodynamic endpoint for future studies. (This study has been registered at the ISRCTN registry under no. ISRCTN59144167.).Item Open Access Printing amphotericin B on microneedles using matrix-assisted pulsed laser evaporation.(International journal of bioprinting, 2017-01) Sachan, Roger; Jaipan, Panupong; Zhang, Jennifer Y; Degan, Simone; Erdmann, Detlev; Tedesco, Jonathan; Vanderwal, Lyndsi; Stafslien, Shane J; Negut, Irina; Visan, Anita; Dorcioman, Gabriela; Socol, Gabriel; Cristescu, Rodica; Chrisey, Douglas B; Narayan, Roger JTransdermal delivery of amphotericin B, a pharmacological agent with activity against fungi and parasitic protozoa, is a challenge since amphotericin B exhibits poor solubility in aqueous solutions at physiologic pH values. In this study, we have used a laser-based printing approach known as matrix-assisted pulsed laser evaporation to print amphotericin B on the surfaces of polyglycolic acid microneedles that were prepared using a combination of injection molding and drawing lithography. In a modified agar disk diffusion assay, the amphotericin B-loaded microneedles showed concentration-dependent activity against the yeast Candida albicans. The results of this study suggest that matrix-assisted pulsed laser evaporation may be used to print amphotericin B and other drugs that have complex solubility issues on the surfaces of microneedles.Item Open Access Role of isavuconazole in the treatment of invasive fungal infections.(Ther Clin Risk Manag, 2016) Wilson, Dustin T; Dimondi, V Paul; Johnson, Steven W; Jones, Travis M; Drew, Richard HDespite recent advances in both diagnosis and prevention, the incidence of invasive fungal infections continues to rise. Available antifungal agents to treat invasive fungal infections include polyenes, triazoles, and echinocandins. Unfortunately, individual agents within each class may be limited by spectrum of activity, resistance, lack of oral formulations, significant adverse event profiles, substantial drug-drug interactions, and/or variable pharmacokinetic profiles. Isavuconazole, a second-generation triazole, was approved by the US Food and Drug Administration in March 2015 and the European Medicines Agency in July 2015 for the treatment of adults with invasive aspergillosis (IA) or mucormycosis. Similar to amphotericin B and posaconazole, isavuconazole exhibits a broad spectrum of in vitro activity against yeasts, dimorphic fungi, and molds. Isavuconazole is available in both oral and intravenous formulations, exhibits a favorable safety profile (notably the absence of QTc prolongation), and reduced drug-drug interactions (relative to voriconazole). Phase 3 studies have evaluated the efficacy of isavuconazole in the management of IA, mucormycosis, and invasive candidiasis. Based on the results of these studies, isavuconazole appears to be a viable treatment option for patients with IA as well as those patients with mucormycosis who are not able to tolerate or fail amphotericin B or posaconazole therapy. In contrast, evidence of isavuconazole for invasive candidiasis (relative to comparator agents such as echinocandins) is not as robust. Therefore, isavuconazole use for invasive candidiasis may initially be reserved as a step-down oral option in those patients who cannot receive other azoles due to tolerability or spectrum of activity limitations. Post-marketing surveillance of isavuconazole will be important to better understand the safety and efficacy of this agent, as well as to better define the need for isavuconazole serum concentration monitoring.