SUBA-itraconazole in the treatment of systemic fungal infections.

Conventional itraconazole (c-ITZ) can be used for a variety of fungal infections although variable absorption has been a significant limitation. Super-bioavailable itraconazole (SUBA-ITZ) is a novel formulation that overcomes absorption concerns by utilizing a polymer-matrix to disperse active drug and facilitate dissolution. The pH-driven matrix allows concurrent proton pump inhibitor administration without significant effects on drug concentrations. The enhanced bioavailability of SUBA-ITZ allows for lower dosing, while achieving similar serum concentrations as c-ITZ and SUBA-ITZ is now US FDA approved in the treatment of blastomycosis, histoplasmosis and aspergillosis. Common side effects of SUBA-ITZ include gastrointestinal disorders, peripheral edema and drug-induced hypertension. Given the significant differences in pharmacokinetics between the formulations, c-ITZ and SUBA-ITZ capsules are not considered interchangeable. It is important to note that drug errors may occur when transitioning a patient from one formulation to another.

Itraconazole is an antifungal agent used in the treatment of a number of mycoses. Prior formulations (versions) of itraconazole required strict dietary requirements and often had poor absorption. A new itraconazole formulation has since been developed ­ super bioavailable itraconazole (SUBA-itraconazole). This has no food requirements, has superior absorption and maintains effectiveness against a number of fungal infections.

ChoLecalciferol and ErgocAliferol Replacement iN CriTically InjurEd BuRN Patients: An Observational Cohort Study (LANTERN).

Vitamin D deficiency appears to be more prevalent than previously considered in the adult critically ill population, and specifically burn-injured patients. No definitive regimen has been shown to restore vitamin D (25(OH)D) levels more effectively to therapeutic levels in the burn-injured population. The purpose of this study was to investigate the effects of either ergocalciferol (D2, 50,000 IU weekly) or cholecalciferol (D3, 6,000 IU daily) in adults with burns ≥ 10% TBSA. This retrospective, observational study (2020-2022) included patients with vitamin D deficiency (< 30 ng/mL) who received replacement and had monitoring with weekly vitamin D levels. Patients on dialysis or those with a hospital length of stay (LOS) less than 2 weeks were excluded. Forty-five patients treated with ergocalciferol and 99 patients with cholecalciferol were included in the study. Patients treated with cholecalciferol were more likely to achieve 25(OH)D levels greater than 30 ng/ml compared to ergocalciferol over a 42-day period (HR 23.56, [95% CI, 12.57-44.16, p<0.0001). A higher proportion of patients in the cholecalciferol group achieved vitamin D greater than 20 ng/ml (HR 6.37, [95% CI, 4.20-9.66, p<0.0001). The adjusted hazard ratios (D3 vs D2) for achieving 25(OH)D levels > 30 ng/ml and > 20 ng/ml were and 23.94 (95% CI 5.09-427.6, p=0.0019) and 7.32 (95% CI 3.83-15.52, p<0.0001) respectively, after controlling for TBSA and initial 25(OH)D. Cholecalciferol appears to be a more effective agent than ergocalciferol for correcting vitamin D deficiency and insufficiency in patients with burn injuries.