Hematolojik maligniteli hastaların febril nötropenik ataklarında vorikonazolün yan etkilerinin değerlendirilmesi
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Date
2010-02-11
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Uludağ Üniversitesi
Abstract
Hematolojik maligniteli febril nötropenik hastalarda, fungal enfeksiyonlar hala önemli morbidite ve mortalite nedenidirler. Vorikonazol, yeni geliştirilen geniş spektrumlu ikinci jenerasyon triazol grubu antifungal olup, aspergillus, candida, fusarium ve scedosporium enfeksiyonlarında etkilidir. İlacın parenteral formunun yanında oral formu da bulunmaktadır. Konvansiyonel amfoterisin B’nin infüzyonu sırasında ateş, titreme gibi infüzyonla ilişkili reaksiyonlar ve hipokalemi, nefrotoksisite gibi yan etkilerle sıkça karşılaşılmaktadır. Çalışmamızda Hematoloji Kliniğimizde Haziran 2006-Ocak 2009 tarihleri arasında yatan hematolojik maligniteli toplam 23 hastanın vorikonazol kullanılmış olan 30 febril nötropeni (FEN) atağını geriye dönük olarak değerlendirdik. Vorikonazol tedavisi 11 atakta (%36,6) kullanılan diğer antifungallere yanıtsızlık, 7 atakta (%23,3) sekonder profilaksi, 12 atakta ise (%40) diğer antifungallere bağlı tedaviyi bıraktıracak derecede ciddi yan etki ortaya çıkması nedeni ile başlandı. Vorikonazole bağlı yan etki olarak, 2 atakta hafif–orta derecede hipokalemi (%6,6), 1 atakta nefrotoksisite (%3,3), 2 atakta hepatotoksisite (%6,6), 1 atakta vizüel halüsinasyon (%3,3) tesbit edildi. Vorikonazolun, hematolojik maligniteli hastalarda kabul edilebilir yan etki profiline sahip olduğu kanaatine varıldı.
In neutropenic patients with hematologic malignancy, fungal infections still have been important cause of morbiditiy and mortality. Voriconazole, new developed a second generation triazol group broad spectrum antifungal, is effective in aspergillus, candida, fusarium and scedosporium infections. Alongside parenteral form of drug, oral form also have been present. During conventional amphotericin B infusion; adverse reactions like hypokalemia, nephrotoxicity and infusion reactions like fever and chill are frequently seen. In our study 30 febrile neutropenic episodes of total 23 patients with high risk hematologic malignancy admitted to our hematology clinic between date of June 2006-January 2009 were retrospectively analysed. Voriconazole had been started because of no replying to other antifungals in 11 episodes (%36,6), seconder profilaxis in 7 episodes (%23,3) and serious advers effects araising from other antifungals resulting in discontinuing this treatment in 12 episodes (%40). Advers effects associated with voriconazole were mild to intermediate hypokalemia in 2 episodes (%6,6), nefrotoxicity in 1 episode (%3,3), hepatotoxicity in 2 episodes (%6,6), visual halusination in 1 episode (%3,3). It has been suggested that voriconazol has acceptable advers effect profile in patients with hematologic malignancy.
In neutropenic patients with hematologic malignancy, fungal infections still have been important cause of morbiditiy and mortality. Voriconazole, new developed a second generation triazol group broad spectrum antifungal, is effective in aspergillus, candida, fusarium and scedosporium infections. Alongside parenteral form of drug, oral form also have been present. During conventional amphotericin B infusion; adverse reactions like hypokalemia, nephrotoxicity and infusion reactions like fever and chill are frequently seen. In our study 30 febrile neutropenic episodes of total 23 patients with high risk hematologic malignancy admitted to our hematology clinic between date of June 2006-January 2009 were retrospectively analysed. Voriconazole had been started because of no replying to other antifungals in 11 episodes (%36,6), seconder profilaxis in 7 episodes (%23,3) and serious advers effects araising from other antifungals resulting in discontinuing this treatment in 12 episodes (%40). Advers effects associated with voriconazole were mild to intermediate hypokalemia in 2 episodes (%6,6), nefrotoxicity in 1 episode (%3,3), hepatotoxicity in 2 episodes (%6,6), visual halusination in 1 episode (%3,3). It has been suggested that voriconazol has acceptable advers effect profile in patients with hematologic malignancy.
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Keywords
Vorikonazol, Yan etki, Febril nötropenik hasta, İnvaziv fungal enfeksiyon, Advers effect, Voriconazole, Febrile neutropenic patient, Invasive fungal infection
Citation
Acet, A. vd. (2009). ''Hematolojik maligniteli hastaların febril nötropenik ataklarında vorikonazolün yan etkilerinin değerlendirilmesi''. Uludağ Üniversitesi Tıp Fakültesi Dergisi, 35(3), 137-141.