Choosing the Right Antifungal Agent in ICU Patients

Risultato della ricerca: Article

Abstract

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.
Lingua originaleEnglish
pagine (da-a)3308-3320
Numero di pagine13
RivistaAdvances in Therapy
Volume36
Stato di pubblicazionePublished - 2019

Fingerprint

Antifungal Agents
Intensive Care Units
Echinocandins
Candidemia
Polyenes
Azoles
Drug Interactions
Fungi
Pharmacokinetics
Guidelines
Kidney
Liver
Incidence
Therapeutics
Infection
Serum
Invasive Fungal Infections

Cita questo

Choosing the Right Antifungal Agent in ICU Patients. / Cortegiani, Andrea.

In: Advances in Therapy, Vol. 36, 2019, pag. 3308-3320.

Risultato della ricerca: Article

@article{ccae2b6e896b41839986f01432745f55,
title = "Choosing the Right Antifungal Agent in ICU Patients",
abstract = "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.",
author = "Andrea Cortegiani",
year = "2019",
language = "English",
volume = "36",
pages = "3308--3320",
journal = "Advances in Therapy",
issn = "0741-238X",
publisher = "Health Communications Inc.",

}

TY - JOUR

T1 - Choosing the Right Antifungal Agent in ICU Patients

AU - Cortegiani, Andrea

PY - 2019

Y1 - 2019

N2 - 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.

AB - 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.

UR - http://hdl.handle.net/10447/385468

M3 - Article

VL - 36

SP - 3308

EP - 3320

JO - Advances in Therapy

JF - Advances in Therapy

SN - 0741-238X

ER -