Intravenous itraconazole followed by oral itraconazole in the treatment ofinvasive pulmonary aspergillosis in patients with hematologic malignancies, chronic granulomatous disease, or AIDS

The pharmacokinetics, efficacy, and safety of intravenous (iv) itraconazole (2 days at 400 mg/day, 12 days at 200 mg/day), followed by 12 weeks of ora l capsules (400 mg/day) were studied in 31 immunocompromised patients with pulmonary invasive aspergillosis. All patients received iv itraconazole (me dian duration, 14 days), and 26 then received oral itraconazole (median dur ation, 78.5 days). After receiving iv itraconazole, concentrations increase d rapidly, with trough plasma levels greater than or equal to 250 ng/mL in 91% of patients and in all patients by day 7. Concentrations greater than o r equal to 500 ng/mL were observed in 64% of patients by day 2. Mean trough concentrations after 2 and 14 days were 670 and 850 ng/mL, respectively. T herapeutic levels were maintained after switching to oral capsules. A compl ete or partial response was seen at the last on-treatment assessment in 15 (48%) of 31 patients, with 6 (19%) showing stable disease. Itraconazole was well tolerated, with no unexpected effects. Overall iv/oral itraconazole w as safe and effective in invasive aspergillosis.