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Release date: February 14, 2008 ACPE Release Date: December 3, 2007 Expiration date: February 28, 2009 Estimated time to complete activity: 1.5 hours |
Read through all material and click "Begin activity" at the bottom of the page. |
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Support for this activity has been provided through an educational grant from
Activity Overview
The incidence of invasive fungal infections has increased recently, primarily as a consequence of a rise in the number of immunocompromised and immunosuppressed patients. Although strategies are available for managing immunocompromised hematology-oncology patients, the prognosis for these patients is generally poor. Emerging resistance to routine therapeutic agents, increased infections with pathogens that are less common, and comorbidities are among the greatest challenges these patients present to the practicing clinician. This activity addresses the issue of identifying patients most at risk for invasive fungal infections and presents treatment options and strategies for managing patients with invasive fungal infections in the inpatient setting.
Target Audience
This activity has been designed to meet the educational needs of clinical pharmacists and other health care professionals involved in the care of patients in the hematology-oncology setting.
Learning Objectives
Upon completion of this activity, participants should be better able to:
- Indicate the prevalence of opportunistic invasive fungal infections in hospitalized, high-risk hematology-oncology patients
- Describe emerging trends in resistance to current antifungal agents
- Identify risk factors and comorbidities in hospitalized hematology-oncology patients that contribute to their increased susceptibility to invasive fungal infections
- Review the data regarding the role, spectrum of activity, drug interactions, and toxicities of current antifungal agents
Melissa D. Johnson, PharmD—Activity Chair View biography
Associate Professor of Clinical Research
Campbell University School of Pharmacy
Buies Creek, North Carolina
Assistant Professor of Medicine
Division of Infectious Diseases and International Health
Duke University Medical Center
Durham, North Carolina
Helen L. Leather, BPharm, BCPS View biography
Clinical Pharmacy Specialist
Shands at the University of Florida
Gainesville, Florida
Russell E. Lewis, PharmD, FCCP, BCPS View biography
Associate Professor
Department of Clinical Sciences and Administration
University of Houston College of Pharmacy
University of Texas M. D. Anderson Cancer Center
Houston, Texas
Accreditation Statement
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Postgraduate Institute for Medicine is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. |
Credit Designation
Postgraduate Institute for Medicine designates this continuing education activity for 1.5 contact hours (0.15 CEUs) of the Accreditation Council for Pharmacy Education. (Universal Program Number - 809-999-07-098-H01-P).
Participants should not claim credit for this activity if credit was previously claimed for the symposium on which this Web activity is based.
Method of Participation
To receive credit during the period January 31, 2008 to January 31, 2009, participants must (1) read the learning objectives and disclosure statements, (2) study the educational activity, (3) complete the posttest, and (4) complete the activity evaluation form, including the certificate information section.
Participants will then be able to print their certificate for this activity.
Medium
The Internet was selected as the instructional format to accommodate the learning preferences of a significant portion of the target audience.
Disclosure
Postgraduate Institute for Medicine (PIM) assesses conflict of interest with its instructors, planners, managers, and other individuals who are in a position to control the content of CME activities. All relevant conflicts of interest that are identified are thoroughly vetted by PIM for fair balance, scientific objectivity of studies utilized in this activity, and patient care recommendations. PIM is committed to providing its learners with high-quality CME activities and related materials that promote improvements or quality in health care and not a specific proprietary business interest of a commercial interest.
The faculty members have reported the following financial relationships or relationships to products or devices they or their spouses/life partners have with commercial interests related to the content of this CME activity:
| Faculty | Reported Areas of Conflict |
| Melissa D. Johnson, PharmD | Consultant: Schering-Plough Research: Astellas, Schering-Plough, Merck, Pfizer Speakers Bureau: Pfizer, Enzon |
| Helen L. Leather, BPharm, BCPS | Consultant: Pfizer, Schering-Plough Speakers Bureau: Pfizer, Schering-Plough |
| Russell E. Lewis, PharmD, FCCP, BCPS | Consultant: Astellas, Enzon,
Schering-Plough Research: Astellas, Enzon, Merck, Schering-Plough Speakers Bureau: Astellas, Enzon, Merck, Pfizer |
The planners and managers have reported the following financial relationships or relationships to products or devices they or their spouses/life partners have with commercial interests related to the content of this CE activity:
Curatio CME Institute Staff
Shari J. Dermer, PhD, Medical Director, has disclosed no relevant financial relationships.
Thomas Finnegan, PhD, Medical Writer, has disclosed no relevant financial relationships.
Danielle Hesser, Program Manager, has disclosed no relevant financial relationships.
Barbara Landers, Vice President, Medical Education Programs, has disclosed no relevant financial relationships.
Jonathan S. Simmons, ELS, Managing Editor, has disclosed no relevant financial relationships.
Postgraduate Institute for Medicine
The following PIM clinical content reviewers, Jan Hixon, RN; Linda Graham, RN; and Trace Hutchison, PharmD, hereby state that they or their spouse/life partner do not have any financial relationships or relationships in any amount during the past 12 months to products, devices, or any commercial interests related to the content of this CE activity.
Disclaimer
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Postgraduate Institute for Medicine (PIM), Curatio CME Institute, and Schering-Plough Corporation do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of PIM, Curatio CME Institute, or Schering-Plough Corporation. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Generic Name |
Trade Name |
Approved Use (if any) |
Unapproved/
Investigational Use |
| Amphotericin B colloidal dispersion | Amphotec® | Treatment of invasive aspergillosis (IA) in patients where renal impairment or unacceptable toxicity precludes the use of amphotericin B deoxycholate in effective doses and in patients with IA where prior amphotericin B deoxycholate therapy has failed | N/A |
| Amphotericin B deoxycholate | Fungizone® | Treatment of progressive, potentially life-threatening, fungal infections | Combination therapy with caspofungin |
| Amphotericin B liposome for injection | AmBisome® | Empiric therapy for presumed fungal infection in febrile, neutropenic patients
Treatment of cryptococcal meningitis in HIV-infected patients; infections with Aspergillus species, Candida species, or Cryptococcus species that are refractory to amphotericin B deoxycholate; patients for whom renal impairment or unacceptable toxicity precludes the use of amphotericin B deoxycholate; visceral leishmaniasis |
Prophylaxis of invasive fungal infections (IFIs) including IA; combination therapy with caspofungin |
| Amphotericin B lipid complex injection | Abelcet® | Treatment of IFIs in patients who are refractory to or intolerant of conventional amphotericin B therapy | Empiric treatment of febrile neutropenia; prophylaxis of IFIs including IA; combination therapy with caspofungin |
| Caspofungin | Cancidas® | Empiric therapy for presumed fungal infections in febrile, neutropenic patients; candidemia and the following Candida infections: intra-abdominal abscesses, peritonitis and pleural space infections; esophageal candidiasis; IA in patients who are refractory to or intolerant of other therapies (ie, amphotericin B, lipid formulations of amphotericin B, and/or itraconazole | Prophylaxis of IFIs including IA; combination therapy with amphotericin B, itraconazole, or voriconazole |
| Fluconazole | Diflucan® | Treatment of vaginal candidiasis (vaginal yeast infections due to Candida); oropharyngeal and esophageal candidiasis; cryptococcal meningitis Prophylaxis: Indicated to decrease the incidence of candidiasis in patients undergoing BMT who receive cytotoxic chemotherapy or radiation therapy | Prophylaxis of IFIs other than Candida in HSCT or high-risk leukemia patients; treatment of other IFIs |
| Itraconazole | Sporonox® | Treatment of the following fungal infections in immunocompromised and nonimmunocompromised patients: blastomycosis, pulmonary and extrapulmonary; histoplasmosis, including chronic cavitary pulmonary disease and disseminated, nonmeningeal histoplasmosis; aspergillosis, pulmonary and extrapulmonary, in patients who are intolerant of or who are refractory to amphotericin B therapy | Prophylaxis of IFIs including IA in HSCT or high risk leukemia patients; combination therapy with caspofungin |
| Micafungin | Mycamine® | Treatment of patients with esophageal candidiasis Prophylaxis of Candida infections in patients undergoing HSCT | Prophylaxis of IFIs other than Candida in HSCT or high-risk leukemia patients |
| Posaconazole | Noxafil® | Prophylaxis of invasive Aspergillus and Candida infections in patients 13 years of age and older who are at high risk of developing these infections due to being severely immunocompromised,such as HSCT recipients with GVHD or those with hematologic malignancies with prolonged neutropenia from chemotherapy
Treatment of oropharyngeal candidiasis, including oropharyngeal candidiasis refractory to itraconazole and/or fluconazole |
Treatment of IA |
| Voriconazole | Vfend® | Treatment of IA; candidemia in non-neutropenic patients and the following Candida infections: disseminated infections in skin and infections in abdomen, kidney, bladder wall, and wounds; esophageal candidiasis; serious fungal infections caused by Scedosporium apiospermum (asexual form of Pseudallescheria boydii) and Fusarium spp., including Fusarium solani, in patients intolerant of, or refractory to, other therapy | Prophylaxis of IFIs in HSCT or high-risk leukemia patients; empiric treatment of febrile neutropenia; combination therapy with caspofungin |
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