6533b832fe1ef96bd129ae21
RESEARCH PRODUCT
Choosing the Right Antifungal Agent in ICU Patients
Jeanne ChatelonMarc LeoneAndrea CortegianiNadim CassirEmmanuelle Hammadsubject
AzolesAntifungal AgentsReviewKidney Function TestsInvasive aspergillosiEchinocandins0302 clinical medicineLiver Function Tests[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseasesMedicineDrug InteractionsPharmacology (medical)030212 general & internal medicineComputingMilieux_MISCELLANEOUSmedia_common[SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases0303 health sciencesIncidenceIncidence (epidemiology)CandidiasisGeneral MedicineSerum concentrationIntensive care patients3. Good healthIntensive Care UnitsPractice Guidelines as Topic[SDV.MP.VIR]Life Sciences [q-bio]/Microbiology and Parasitology/VirologyCandidiasiNarrative reviewDrug MonitoringInvasive fungi infectionAntifungalDrugmedicine.medical_specialtyIcu patientsmedicine.drug_classmedia_common.quotation_subjectPharmacokineticPolyenesImmunocompromised Host03 medical and health sciences[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular systemIntensive careHumansPharmacokinetics[SDV.MP.PAR]Life Sciences [q-bio]/Microbiology and Parasitology/ParasitologyIntensive care medicineIntensive care patient030306 microbiologybusiness.industry[SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/BacteriologyInvasive aspergillosisLiver functionbusinessPractical guidelinesInvasive Fungal Infectionsdescription
Fungi are responsible for around 20% of microbiologically documented infections in intensive care units (ICU). In the last decade, the incidence of invasive fungal infections (IFI), including candidemia, has increased steadily because of increased numbers of both immunocompromised and ICU patients. To improve the outcomes of patients with IFI, intensivists need to be aware of the inherent challenges. This narrative review summarizes the features of routinely used treatments directed against IFI in non-neutropenic ICU patients, which include three classes of antifungals: polyenes, azoles, and echinocandins. ICU patients' pathophysiological changes are responsible for deep changes in the pharmacokinetics of antifungals. Moreover, drug interactions affect the response to antifungal treatments. Consequently, appropriate antifungal dosage is a challenge under these special conditions. Dosages should be based on renal and liver function, and serum concentrations should be monitored. This review summarizes recent guidelines, focusing on bedside management.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2019-12-01 | Advances in Therapy |