betadex and posaconazole

Invasive fungal wound infections (IFIs) were an unexpected complication associated with blast-related wounds during Operation Enduring Freedom. Between 2010 and 2012, IFI incidence rates were as high as 10-12% for patients injured during Operation Enduring Freedom and admitted to the intensive care unit at the Landstuhl Regional Medical Center. Independent risk factors for the development of IFIs include dismounted blast injuries, above knee amputations and massive (>20 units) packed red blood cell transfusions within 24 hours after injury. The Joint Trauma System developed a Clinical Practice Guideline on IFI prevention, identification and management. Aggressive and frequent surgical debridement remains the primary therapy accompanied by topical antifungal therapy (e.g., Dakins solution). Empiric systemic antifungal therapy with both liposomal amphotericin B and an intravenous broad-spectrum triazole (e.g., voriconazole or posaconazole) should be administered when there is strong suspicion of IFI based on the occurrence of recurrent wound necrosis following serial surgical debridements, since many cases involve multiple fungal species. Other recommendations include: (1) early tissue sampling for wound histopathology and fungal cultures, (2) early consultation with infectious disease specialists, and (3) coordination with surgical pathology and clinical microbiology.

Topics: Administration, Topical; Afghan Campaign 2001-; Amphotericin B; Antifungal Agents; beta-Cyclodextrins; Debridement; Excipients; Humans; Mycoses; Recurrence; Risk Factors; Tobramycin; Treatment Outcome; Triazoles; Vancomycin; Voriconazole; Wounds and Injuries

Posaconazole is a triazole antifungal drug that with extremely poor aqueous solubility. Up to now, this drug can be administered via intravenous injection and oral suspension. However, its oral bioavailability is greatly limited by the dissolution rate of the drug. This study aimed to improve water solubility and dissolution of posaconazole through characterizing the inclusion complexes of posaconazole with β-cyclodextrin (β-CD) and 2,6-di-O-methyl-β-cyclodextrin (DM-β-CD). Phase solubility studies were performed to calculate the stability constants in solution. The results of FT-IR, PXRD,

Topics: Antifungal Agents; beta-Cyclodextrins; Calorimetry, Differential Scanning; Solubility; Spectroscopy, Fourier Transform Infrared; Triazoles; Water

This study aimed to prepare and characterize the inclusion complex between posaconazole (POS) and hydroxypropyl-β-cyclodextrin (HP-β-CD). Phase solubility study was conducted to investigate the drug/CD interaction in solution, including the stoichiometry and apparent stability constant. The solid complex (HP-β-CD-POS) obtained was characterized through Fourier transform infrared spectroscopy, powder X-ray diffraction, (1)H and ROESY 2D nuclear magnetic resonance, differential scanning calorimetry, and scanning electron microscopy. These approaches confirmed the formation of the inclusion complex. The HP-β-CD-POS inclusion complex exhibited better water solubility and higher dissolution rate than the free POS did; the water solubility of POS was increased by 82 times and almost 90% of the loaded drug dissolved after 10 min in the dissolution media. In addition, preliminary in vitro antifungal susceptibility testing revealed that HP-β-CD-POS maintains a high level of antifungal activities. Therefore, the HP-β-CD complex may be useful in the delivery of posaconazole.

Topics: 2-Hydroxypropyl-beta-cyclodextrin; Antifungal Agents; beta-Cyclodextrins; Drug Carriers; Fungi; Humans; Models, Molecular; Mycoses; Solubility; Triazoles; Water

We present a 31-year-old female who had undergone an allogeneic bone marrow transplantation and who was started on intravenous posaconazole for pulmonary mycosis while undergoing continuous venovenous hemofiltration (CVVH). We performed steady-state pharmacokinetic evaluations for both posaconazole and sulfobutylether-β-cyclodextrin (SBECD). SBECD was effectively removed by CVVH, with observed exposure similar to that for patients with moderate renal impairment. Intravenous posaconazole at standard doses may be utilized in critically ill patients undergoing CVVH without significant risk of SBECD accumulation.

Topics: Administration, Intravenous; Adult; beta-Cyclodextrins; Critical Illness; Cyclodextrins; Female; Hemofiltration; Humans; Triazoles