Comparison of Characteristics of Patients who Received Posaconazole or Voriconazole for the Treatment of Coccidioidomycosis

Abstract

Specific Aims: To describe the characteristics of patients who were switched to or prescribed posaconazole or voriconazole for the treatment of coccidioidomycosis including duration of previous anti-fungal treatment and rationale for changing from the first-line agents to posaconazole or voriconazole. Methods: This was a retrospective medical chart review of all patients admitted to an academic medical center with a diagnosis of coccidioidomycosis and prescribed posaconazole or voriconazole between January 2008 and December 2011. Subjects for the study were identified by ICD-9 codes for coccidioidomycosis (114.0-114.9) and through the pharmacy system for orders for posaconazole or voriconazole. Data collected included demographic information, antifungal prescription data, and outcome of fungal infection, if available. Main Results: A total of 41 subjects were identified as being prescribed either voriconazole or posaconazole for a diagnosis for coccidioidomycosis. The majority of subjects were prescribed voriconazole (93%) rather than posaconazole. While the majority of subjects were diagnosed with only pulmonary disease, 44% of subjects’ coccidioidomycosis diagnoses were classified as disseminated and 46% were admitted to an intensive care unit. The median (range) duration of first-line antifungal therapy was 3 (2-10) days for the posaconazole group and 3 (0-25) days for the voriconazole group. Overall, the reason(s) for switching antifungal therapy was listed as: failure of first-line therapy (26%), adverse drug event (4.3%), other (35%), and unknown (35%). Conclusion: There was no significant difference in baseline or disease characteristics between patients who were prescribed voriconazole or posaconazole for coccidioidomycosis. The main limitation of this retrospective evaluation is that the reason for use of voriconazole or posaconazole rather than first-line agents was often not easily determined based on the documentation in the medical records.