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Annals of Hematology

, Volume 93, Issue 1, pp 33–42 | Cite as

The relationship between the success rate of empirical antifungal therapy with intravenous itraconazole and clinical parameters, including plasma levels of itraconazole, in immunocompromised patients receiving itraconazole oral solution as prophylaxis: a multicenter, prospective, open-label, observational study in Korea

  • Jin Seok Kim
  • June-Won Cheong
  • Yeo-Kyeoung Kim
  • Jinny Park
  • Yeung-Chul Mun
  • Hye Jin Kang
  • Hyeon Gyu Yi
  • Je-Hwan Lee
  • Yang Soo Kim
  • Hun-Mo Ryoo
  • Sung-Hyun Kim
  • Ho Young Kim
  • Jin Young Kim
  • Dong-Gun Lee
  • Hoon-Gu Kim
  • Hawk Kim
  • Young-Don JooEmail author
  • Yoo Hong MinEmail author
Original Article

Abstract

To identify the role of therapeutic drug monitoring of itraconazole (ITZ) in the setting of empirical antifungal therapy with intravenous (IV) ITZ, we performed a multicenter, prospective study in patients with hematological malignancies who had received antifungal prophylaxis with ITZ oral solution (OS). We evaluated the plasma levels of ITZ and hydroxy (OH) ITZ both before initiation of IV ITZ and on days 5–7 of IV ITZ. A total of 181 patients showed an overall success rate of 68.0 %. Prolonged baseline neutropenia and accompanying cardiovascular comorbidity were significantly associated with poor outcomes of the empirical antifungal therapy (P = 0.005 and P = 0.001, respectively). A significantly higher trough plasma level of OH ITZ per body weight was found in the patients who achieved success with empirical antifungal therapy (P = 0.036). There were no significant correlations between plasma concentrations of ITZ/OH ITZ (baseline or trough levels) and toxicities. Seven patients had a discontinuation of ITZ therapy due to toxicity. This study demonstrated that IV ITZ as empirical antifungal therapy was effective and therapeutic drug monitoring was helpful to estimate the outcome of empirical antifungal therapy in patients receiving antifungal prophylaxis with ITZ OS. To predict the outcome of empirical antifungal therapy with IV ITZ, we should evaluate baseline clinical characteristics and also perform the therapeutic drug monitoring of both ITZ and OH ITZ.

Keywords

Hematological malignancy itraconazole Hydroxy itraconazole Empirical antifungal therapy Therapeutic drug monitoring 

Notes

Acknowledgments

This work was supported in part by a grant from Janssen Korea, Seoul, South Korea. We thank all the nurses and doctors who were involved in caring for the patients.

Conflict of interest

The authors declare that they have no other conflict of interest besides receiving the grant.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Jin Seok Kim
    • 1
  • June-Won Cheong
    • 1
  • Yeo-Kyeoung Kim
    • 2
  • Jinny Park
    • 3
  • Yeung-Chul Mun
    • 4
  • Hye Jin Kang
    • 5
  • Hyeon Gyu Yi
    • 6
  • Je-Hwan Lee
    • 7
  • Yang Soo Kim
    • 8
  • Hun-Mo Ryoo
    • 9
  • Sung-Hyun Kim
    • 10
  • Ho Young Kim
    • 11
  • Jin Young Kim
    • 12
  • Dong-Gun Lee
    • 13
  • Hoon-Gu Kim
    • 14
  • Hawk Kim
    • 15
  • Young-Don Joo
    • 16
    Email author
  • Yoo Hong Min
    • 1
    Email author
  1. 1.Division of Hematology, Department of Internal MedicineYonsei University College of Medicine, Severance HospitalSeodaemun-guSouth Korea
  2. 2.Department of Hematology-OncologyChonnam National University Hwasun HospitalJeollanam-doSouth Korea
  3. 3.Departments of Internal MedicineGachon University Gil Medical CenterIncheonSouth Korea
  4. 4.Department of Internal MedicineEwha Womans University School of MedicineSeoulSouth Korea
  5. 5.Department of Internal MedicineKorea Cancer Center Hospital, Korea Institute of Radiological and Medical SciencesSeoulSouth Korea
  6. 6.Department of Internal MedicineInha University College of MedicineIncheonSouth Korea
  7. 7.Department of HematologyAsan Medical Center,University of Ulsan College of MedicineSeoulSouth Korea
  8. 8.Department of Internal MedicineKosin University College of MedicineBusanSouth Korea
  9. 9.Department of Internal MedicineDaegu Catholic University Medical CenterDaeguSouth Korea
  10. 10.Department of Internal MedicineDong-A University College of MedicineBusanSouth Korea
  11. 11.Department of Internal MedicineHallym University Sacred Heart HospitalAnyangSouth Korea
  12. 12.Department of Internal MedicineDongsan Medical Center, Keimyung University School of MedicineDaeguSouth Korea
  13. 13.Department of Internal MedicineSeoul St. Mary’s Hospital, College of Medicine, The Catholic University of KoreaSeoulSouth Korea
  14. 14.Department of Internal MedicineGyeongsang National UniversityJinjuSouth Korea
  15. 15.Division of Hematology and Hematological MalignanciesUlsan University Hospital, University of Ulsan College of MedicineUlsanKorea
  16. 16.Department of Internal medicineInje University Haeundae Paik HospitalHaeundae-guSouth Korea

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