Posaconazole approved for the treatment of oropharyngeal candidiasis
FDA approved indications for the use of posaconazole include: prevention of invasive fungal infections caused by Aspergillus and Candida fungi in immunocompromised patients 13 years of age and more, including patients after bone marrow transplantation with host response transplantation, and patients with hematopoietic tissue tumors with prolonged neutropenia due to chemotherapy.
In October 2006, the FDA approved a new indication for the use of an oral suspension of posaconazole 40 mg / ml (Naxafil, Schering-Plow Corp.), which allows its use in treatment oropharyngeal candidiasis, including candidiasis resistant to treatment with itraconazole and fluconazole.
According to a study by judge Vazquez et al., It has been shown that the use of posaconazole in the treatment of oropharyngeal candidiasis in patients infected with HIV can reach similar levels of clinical and mycological efficacy in 14 days compared to to fluconazole therapy (91.7% vs 92, 5% and 52.1% vs 50.0%, respectively). The frequency of clinical and mycological relapses 4 weeks after treatment was also comparable (29.0% vs 35.1% and 55.6% vs 63.7%, respectively )
According to another study by Skiest DJ et al., Similar clinical efficacy has been demonstrated for the treatment of resistant forms of oropharyngeal candidiasis in HIV-infected patients using 2 modes: the first included the use of posaconazole 400 mg / 2 times a day for 3 days and 400 mg for the next 25 days; the second is posaconazole 400 mg / twice daily for 28 days (73.3% vs 75.0%, respectively). One of the criteria for inclusion in the study was the ineffectiveness or worsening of the symptoms of oropharyngeal candidiasis after ten days of treatment with fluconazole 100 mg / day or more and itraconazole (200 mg / day).
The recommended dosage for patients with oropharyngeal candidiasis is 100 mg (2.5 ml) twice daily (saturation dose) on the first day and 100 mg / day for the following 13 days. In the treatment of stable forms of oropharyngeal candidiasis, it is not necessary to prescribe doses of saturation with posaconazole; in such situations, it is recommended that 400 mg (10 ml) of posaconazole be administered twice daily for an appropriate period, depending on the underlying condition and clinical efficacy.