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Breakpoints for posaconazole susceptibility testing: background and discussion about the need of establishing values
1Faculty of Medicine Mannheim, Institute of Medical Microbiology and Hygiene, University of Heidelberg, Heidelberg, Germany. ralf.fleck@imh.ma.uni-heidelberg.de
Abstract:
Posaconazole is a new antifungal agent, which exhibits a broad spectrum of activity against fungi including Aspergillus terreus, some zygomycetes and dematiaceous fungi. Out of the group of triazole antifungal agents, it is the only compound for which interpretive breakpoints have not been established have not yet been established for Candida spp. As reliable breakpoints are useful in the practical management of patients with fungal infections, it is desirable to establish the same for all available substances. However, the underlying data of the existing breakpoints for other antifungal agents are of varying quality because of limited clinical data available. Furthermore, these breakpoints are not equally suitable for all testing methods available and they may not be suitable for all species to be tested. From the practical point of view, it is therefore important not only to establish breakpoints for the reference method but also for the inexpensive and easy to perform testing methods, which are suitable for smaller laboratories.
Insights
Establishing interpretive breakpoints for posaconazole is crucial for managing fungal infections. This is essential for Candida species, especially given the varying quality of existing antifungal breakpoints and testing methods.
Area of Science:
- Mycology
- Clinical Pharmacology
- Antimicrobial Resistance
Background:
- Posaconazole is a broad-spectrum triazole antifungal agent with activity against various fungi, including Aspergillus terreus, zygomycetes, and dematiaceous fungi.
- It is the only triazole antifungal agent lacking established interpretive breakpoints for Candida species.
- Reliable breakpoints are vital for effective clinical management of fungal infections.
Purpose of the Study:
- To highlight the need for establishing interpretive breakpoints for posaconazole against Candida species.
- To address the limitations of existing antifungal breakpoints regarding data quality and suitability for different testing methods and species.
- To emphasize the importance of developing breakpoints for both reference and accessible, cost-effective testing methods for smaller laboratories.
Main Methods:
- The abstract does not detail specific experimental methods but discusses the general need for breakpoint establishment.
- It implies a review or analysis of existing breakpoint data and testing methodologies.
- Focus is on the practical requirements for clinical laboratory settings.
Main Results:
- Posaconazole demonstrates broad antifungal activity.
- Interpretive breakpoints for posaconazole in Candida species are currently unavailable.
- Existing breakpoints for other antifungals vary in quality and applicability across different methods and species.
Conclusions:
- Establishing interpretive breakpoints for posaconazole against Candida species is a clinical necessity.
- Breakpoints should be developed considering the quality of underlying data and suitability for diverse testing methods, including those used in smaller labs.
- Standardized breakpoints will improve the practical management of patients with posaconazole-treated fungal infections.
