0
Original Research: RESPIRATORY INFECTIONS |

Posaconazole Therapy for Chronic Refractory Coccidioidomycosis*

David A. Stevens, MD; Adrian Rendon, MD; Veronica Gaona-Flores, MD; Antonino Catanzaro, MD, FCCP; Gregory M. Anstead, MD; Lisa Pedicone, PhD; J. Richard Graybill, MD
Author and Funding Information

*From the Santa Clara Valley Medical Center/Stanford University (Dr. Stevens), San Jose, CA; Hospital Universitario Dr. J. E. Gonzalez (Dr. Rendon), Nuevo Leon, Mexico; Hospital de Infectologia CMN La Raza (Dr. Gaona-Flores), La Raza PB, Mexico; University of California at San Diego Medical Center (Dr. Catanzaro), San Diego, CA; University of Texas Health Sciences Center (Drs. Anstead and Graybill), San Antonio, TX; Schering-Plough Research Institute (Dr. Pedicone), Kenilworth, NJ.

Correspondence to: David A. Stevens, MD, Division of Infectious Diseases, Department of Medicine, Santa Clara Valley Medical Center, 751 South Bascom Ave, San Jose, CA 95128-2699; e-mail: stevens@stanford.edu



Chest. 2007;132(3):952-958. doi:10.1378/chest.07-0114
Text Size: A A A
Published online

Background: Coccidioides infections often result in chronic relapsing disease that presents a challenge to the currently available therapy. Posaconazole, an oral extended-spectrum triazole agent, has been shown in vitro and in vivo to have potent activity against this fungus.

Methods: An open-label multinational study of posaconazole, 800 mg/d, administered in divided doses for the treatment of invasive fungal infection that has been refractory to previous therapy was conducted. The data were reviewed by an independent data review committee (DRC). Fifteen patients met the criteria for proven coccidioidal infection and disease refractory to previous therapy. Success was a complete or partial response; nonsuccess was stable disease, lack of response to therapy, or undetermined response.

Results: The sites of coccidioidal infection were pulmonary (seven patients) and disseminated (eight patients). Patients were refractory to previous therapy (including amphotericin B with or without an azole) for a median duration of 306 days. At the end of treatment (posaconazole treatment duration, 34 to 365 days), therapy for 11 of 15 patients (73%) was considered to be successful by the DRC. Four responses were complete and seven were partial; these included five patients with pulmonary sites and six patients with disseminated sites. In responders, improvement was seen within months of the initiation of therapy. Five patients received therapy for ≥ 12 months. The side effects were minimal.

Conclusions: Therapy for coccidioidomycosis remains a clinical challenge, especially when patients have not responded to therapy with drugs that were recommended in treatment guidelines. The success rate (73%) achieved in this case series suggests that oral posaconazole should be considered as an important agent for the treatment of refractory coccidioidomycosis.


Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

CHEST Journal Articles
PubMed Articles
Coccidioidomycosis: Recent Updates. Semin Respir Crit Care Med 2015;36(5):746-55.
Posaconazole: Use in the Prophylaxis and Treatment of Fungal Infections. Semin Respir Crit Care Med 2015;36(5):767-85.
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543