Alternative approaches to the therapeutic drug monitoring of prophylactic posaconazole in haematology patients.

OBJECTIVE: The intention of the study was to assess whether a unique daily specimen is adequate for prophylactic posaconazole TDM in haematology patients and if bioassay and HPLC produce similar results and could be equally used in clinical setting. METHOD: Serum specimens from thirty haematology patients were collected at the end of the first and second week of treatment, just before the morning dose, 2 and 6 to 8hours afterwards. Levels were measured by bioassay in 157 specimens and additionally by HPLC in 51 of them. RESULTS: Bioassay levels were correlated inter and intra daily, with no statistical difference between them, irrespective of the timing. The same was true for HPLC measurements. There was no statistical difference between bioassay (median: 1.60mg/L, interquartile range: 0.60-2.30) and HPLC levels (median: 1.16mg/L, interquartile range: 0.56-1.72), while they were significantly correlated. CONCLUSION: In clinically stable haematology patients, a random specimen on any day after steady state serum concentrations have been achieved is probably adequate in order to monitor posaconazole levels. In the case of monotherapy, a bioassay is an acceptable alternative to HPLC.

Epidemiology of superficial mycoses in Northern Greece: a 4-year study.

BACKGROUND: Superficial mycoses are defined as the fungal infections of skin, hair or nails that are caused by dermatophytes, yeasts and non-dermatophytic moulds. Dermatophytes are the most frequently isolated fungi from specimens of patients with superficial mycoses. OBJECTIVE: Studying the possible alteration of the epidemiology of superficial mycoses in Northern Greece during the last two to three decades. MATERIALS AND METHODS: Data concerning the superficial mycoses from patients coming mainly from the region of Macedonia, Northern Greece, between January 2010 and January 2014 were recorded and analysed. They included specimens from 438 patients (146 M/292 F), within an age range of 2-85 years old. 503 samples were collected from skin (81, 16.1%), hair (18, 3.6%) and nails (fingernails 84, 16.7%, toenails 320, 63.6%) lesions. RESULTS: Of a total of 222 positive cultures, 50 were considered as yielding clinically non-significant isolates (saprophytes). Among the rest (172), dermatophytes were the most prevalent isolates (102, 59.3%), followed by yeasts (51, 29.7%) and non-dermatophytic moulds (19, 11%). Trichophyton rubrum (55, 53.9%), Trichophyton mentagrophytes (18, 17.6%) and Microsporum canis (23, 22.5%) were the most common isolates among dermatophytes (total = 102). Candida parapsilosis (26, 51%), and Candida albicans (10, 19.6%) among yeasts (total = 51) whereas Fusarium (6, 31.6%) and Acremonium species (3, 15.8%) among the non-dermatophytic moulds (total=19). CONCLUSION: Compared to previous studies from Northern Greece, the epidemiology of superficial mycoses in the specific geographic region seems not to have been altered the last two to three decades.