Zygomycosis, an
infection that is associated with significant morbidity and mortality, is becoming common in immunocompromised patients.
Posaconazole is a new extended-spectrum
azole antifungal that has demonstrated in vitro and in vivo activity against zygomycetes. This report provides the results from the first 24 patients with active
zygomycosis who were enrolled in two open-label, nonrandomized, multicentered compassionate trials that evaluated oral
posaconazole as
salvage therapy for
invasive fungal infections.
Posaconazole was usually given as an oral
suspension of 200 mg four times a day or 400 mg twice a day. Eleven (46%) of the
infections were rhinocerebral. Duration of
posaconazole therapy ranged from 8 to 1,004 days (mean, 292 days; median, 182 days). Rates of successful treatment (complete cure and partial response) were 79% in 19 subjects with
zygomycosis refractory to standard
therapy and 80% in 5 subjects with intolerance to standard
therapy. Overall, 19 of 24 subjects (79%) survived
infection. Survival was also associated with surgical resection of affected tissue and stabilization or improvement of the subjects' underlying illnesses. Failures either had worsening of underlying illnesses or requested all
therapy withdrawn; none of the failures received more than 31 days of
posaconazole.
Posaconazole oral
solution was well tolerated and was discontinued in only one subject due to a
drug rash.
Posaconazole appears promising as an oral
therapy for
zygomycosis in patients who receive required surgery and control their underlying illness.