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Voriconazole as Therapy for Systemic Penicillium marneffei Infections in AIDS Patients

The objective of this study was to evaluate the triazole anti-fungal agent, voriconazole, as therapy for systemic Penicillium marneffei infections in patients with advanced HIV infection. Patients with systemic P. marneffei infection were enrolled into a study of voriconazole for the treatment of less common, emerging, or refractory fungal infections. Patients were eligible for inclusion in the study on the basis that no anti-fungal agents have received regulatory approval specifically for P. marneffei infections. Patients were treated in the hospital setting with intravenous voriconazole (6 mg/kg every 12 hours on Day 1 and then 4 mg/kg every 12 hours for at least 3 days, after which patients could switch to oral therapy at 200 mg twice a day) or as outpatients with oral voriconazole (400 mg twice a day on Day 1 and then 200 mg twice a day) for a maximum of 12 weeks. Eleven patients received treatment with voriconazole. Two received short courses of intravenous therapy followed by the oral formulation; nine were treated with oral voriconazole only. At the end of therapy, eight of the nine evaluable patients had favorable response to therapy, based on mycological and clinical findings. There were no relapses of P. marneffei infection in the six patients who were seen at follow-up within 4 weeks of the end of therapy. Treatment with voriconazole was well tolerated, with no discontinuations caused by drug-related adverse events. The results of this study suggest that voriconazole is an effective, well-tolerated, and convenient option for the treatment of systemic infections with P. marneffei.

Received September 22, 2004. Accepted for publication April 5, 2006.

Disclosure: H. T. Schlamm is an employee of Pfizer Inc. This statement is made in the interest of full disclosure and not because the author considers this to be a conflict of interest.

^* Address correspondence to Haran T. Schlamm, MD, Pfizer Global Research and Development, Pfizer Inc., 235 East 42nd Street, New York, NY 10017. E-mail: Haran.T.Schlamm{at}pfizer.com

Authors’ addresses: Khuanchai Supparatpinyo, Department of Internal Medicine, Faculty of Medicine, Division of Infectious Disease, Chiang Mai University, 110 Intavaroros Road, Chiang Mai, 50200, Thailand. Haran T. Schlamm, Pfizer Global Research and Development, Pfizer Inc., 235 East 42nd Street, New York, NY 10017.

Reprint requests: Haran T. Schlamm, Pfizer Global Research and Development, Pfizer Inc., 235 East 42nd Street, New York, NY 10017. E-mail: Haran.T.Schlamm{at}pfizer.com.