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Goodlet KJ, McCreary EK, Nailor MD, Barnes D, Brokhof MM, Bova S, Clemens E, Kelly B, Lichvar A, Pluckrose DM, Summers BB, Szempruch KR, Tchen S. Therapeutic Myths in Solid Organ Transplantation Infectious Diseases. Open Forum Infect Dis 2024; 11:ofae342. [PMID: 38983710 PMCID: PMC11232700 DOI: 10.1093/ofid/ofae342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 06/12/2024] [Indexed: 07/11/2024] Open
Abstract
Infection management in solid organ transplantation poses unique challenges, with a diverse array of potential pathogens and associated antimicrobial therapies. With limited high-quality randomized clinical trials to direct optimal care, therapeutic "myths" may propagate and contribute to suboptimal or excessive antimicrobial use. We discuss 6 therapeutic myths with particular relevance to solid organ transplantation and provide recommendations for infectious diseases clinicians involved in the care of this high-risk population.
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Affiliation(s)
- Kellie J Goodlet
- Department of Pharmacy Practice, Midwestern University, Glendale, Arizona, USA
| | - Erin K McCreary
- Department of Medicine, Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Michael D Nailor
- Department of Pharmacy Services, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Darina Barnes
- Department of Pharmacy, Comprehensive Transplant Center, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Marissa M Brokhof
- Department of Pharmacy, Rush University Medical Center, Chicago, Illinois, USA
| | - Sarah Bova
- Department of Pharmacy, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Evan Clemens
- Department of Pharmacy, University of Washington Medical Center, Seattle, Washington, USA
| | - Beth Kelly
- Department of Pharmacy, Indiana University Health, Indianapolis, Indiana, USA
| | - Alicia Lichvar
- Center for Transplantation, UC San Diego Health, San Diego, California, USA
| | - Dawn M Pluckrose
- Department of Pharmacy, Tufts Medical Center, Boston, Massachusetts, USA
| | - Bryant B Summers
- Comprehensive Transplant Center, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Kristen R Szempruch
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - Stephanie Tchen
- Department of Pharmacy, Froedtert Hospital, Milwaukee, Wisconsin, USA
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Gardiner BJ, Lee SJ, Robertson AN, Cristiano Y, Snell GI, Morrissey CO, Peleg AY, Westall GP. Real-world experience of Quantiferon®-CMV directed prophylaxis in lung transplant recipients. J Heart Lung Transplant 2022; 41:1258-1267. [DOI: 10.1016/j.healun.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 04/07/2022] [Accepted: 05/13/2022] [Indexed: 10/18/2022] Open
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Truong CN, Nailor MD, Walia R, Cherrier L, Nasar A, Goodlet KJ. Reply to Al-Obaidi et al. Clin Infect Dis 2021; 74:1886-1887. [PMID: 34596214 DOI: 10.1093/cid/ciab879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Clover N Truong
- Department of Pharmacy Services, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Michael D Nailor
- Department of Pharmacy Services, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Rajat Walia
- Division of Transplant Pulmonology, Norton Thoracic Institute, Dignity Health, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Lauren Cherrier
- Department of Pharmacy Services, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.,Division of Transplant Pulmonology, Norton Thoracic Institute, Dignity Health, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Aasya Nasar
- Department of Pharmacy Services, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.,Division of Transplant Pulmonology, Norton Thoracic Institute, Dignity Health, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Kellie J Goodlet
- Department of Pharmacy Practice, Midwestern University College of Pharmacy, Glendale, AZ, USA
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Franck B, Autmizguine J, Marquet P, Ovetchkine P, Woillard JB. Pharmacokinetics, Pharmacodynamics, and Therapeutic Drug Monitoring of Valganciclovir and Ganciclovir in Transplantation. Clin Pharmacol Ther 2021; 112:233-276. [PMID: 34596243 DOI: 10.1002/cpt.2431] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 09/20/2021] [Indexed: 01/17/2023]
Abstract
Ganciclovir and valganciclovir are first choice drugs for the prevention and treatment of cytomegalovirus infection and disease in solid organ and stem cell transplant recipients. Only a few studies on the pharmacokinetics and exposure/efficacy or exposure/safety relationships of ganciclovir and valganciclovir in transplant recipients have been published so far, and there are still controversies about the exposure parameter to use for therapeutic drug monitoring (TDM). We performed an extensive literature review of the clinical pharmacokinetics data, the exposure/effect relationships in terms of efficacy and safety, and the available tools for valganciclovir and ganciclovir TDM in adults and pediatrics transplant recipients. The pharmacokinetics of ganciclovir and valganciclovir is well described in adults and children, and a high interindividual variability is commonly observed. In contrast, the drug pharmacodynamics has been poorly described in adults and barely in children. The average 24-hour area under the concentration-time curve (AUC0-24h ) seems to be the best predictor of efficacy and toxicity. The benefit of TDM remains controversial in adult patients but should be considered in children due to higher interindividual variability and lower probability of target attainment. Several bayesian estimators based on limited sampling strategies have been developed with this aim and may be used in clinical practice for the AUC-based individual dose adjustment of ganciclovir and valganciclovir.
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Affiliation(s)
- Bénédicte Franck
- Individual Profiling and Prevention of Risks With Immunosuppressive Therapies and Transplantations, Unité Mixte de Recherche 1248 Université de Limoges, Institut National de la Santé et de la Recherche Médicale, Limoges, France.,Service de Pharmacologie, Toxicologie et Pharmacovigilance, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - Julie Autmizguine
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada.,Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada.,Department of Pharmacology and Physiology, Université de Montréal, Montreal, Quebec, Canada
| | - Pierre Marquet
- Individual Profiling and Prevention of Risks With Immunosuppressive Therapies and Transplantations, Unité Mixte de Recherche 1248 Université de Limoges, Institut National de la Santé et de la Recherche Médicale, Limoges, France.,Service de Pharmacologie, Toxicologie et Pharmacovigilance, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - Philippe Ovetchkine
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Jean-Baptiste Woillard
- Individual Profiling and Prevention of Risks With Immunosuppressive Therapies and Transplantations, Unité Mixte de Recherche 1248 Université de Limoges, Institut National de la Santé et de la Recherche Médicale, Limoges, France.,Service de Pharmacologie, Toxicologie et Pharmacovigilance, Centre Hospitalier Universitaire de Limoges, Limoges, France
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