Principles of antifungal therapy

2017 ◽  
Author(s):  
Russell E. Lewis
Keyword(s):  
Antifungal Therapy ◽  
Antifungal Agents ◽  
Fungal Diseases ◽  
Invasive Fungal Diseases ◽  
Correct Dose ◽  
Growing Body ◽  
Extracorporeal Circuits ◽  
Life Threatening ◽  
Poor Outcomes ◽  
Timely Administration

Survival from many life-threatening invasive fungal diseases requires the timely administration of an effective systemic antifungal agent at the correct dose. Although some new antifungal agents have been introduced into clinical practice over the last two decades, each of these antifungals has limitations regarding spectrum, pharmacokinetic/pharmacodynamic properties, toxicity, and cost. Therefore, the selection and dosing of antifungal therapy need to be highly individualized. A growing body of evidence suggests that antifungal therapy is often underdosed, especially in critically ill patients with sepsis, hypoalbunaemia, and extracorporeal circuits. This underdosing may contribute to poor outcomes and increase the risk of antifungal resistance.This chapter discusses some of the drug-specific and host-specific variables clinicians must consider when selecting and dosing antifungal therapy in the treatment of invasive fungal diseases.

Thrombocytosis During Antifungal Therapy of Candidemia

2005 ◽  
Vol 39 (7-8) ◽  
pp. 1238-1243 ◽  
Author(s):  
Angela D Saathoff ◽  
Stephanie L Elkins ◽  
Stanley W Chapman ◽  
Susan Fleming McAllister ◽  
John D Cleary
Keyword(s):  
Antifungal Therapy ◽  
Antifungal Agents ◽  
Epidemiologic Study ◽  
Reactive Thrombocytosis ◽  
Treatment Need ◽  
Platelet Counts ◽  
Life Threatening ◽  
Thrombotic Complications ◽  
Initiation Of Therapy ◽  
Gastrointestinal Tract Bleeding

BACKGROUND Secondary, “reactive,” thrombocytosis has been attributed to bacterial infection and treatment with multiple pharmaceuticals and may be associated with an increase in the incidence of gastrointestinal tract bleeding and thrombotic events (eg, stroke). OBJECTIVE To characterize the dynamics of thrombocytosis in patients with candidemia receiving antifungal therapy. METHODS We initiated a retrospective observational description of patients with candidemia who were treated with antifungal agents. A total of 108 patients diagnosed with candidemia between August 1995 and September 2003 at our teaching hospital were enrolled. Three groups (candidemia with antifungal therapy, candidemia without antifungal therapy, antifungal therapy without candidemia) of patients >18 years of age were evaluated for the resence of thrombocytosis. Platelet administration, pharmacologic or pathologic contributors to thrombocytosis, and other pertinent details related to an elevation of platelet counts were scrutinized. RESULTS Reactive thrombocytosis was observed in approximately 10% of treated patients with candidemia. Within the subgroup developing reactive thrombocytosis, life-threatening thrombotic complications were uncommon. Mean baseline platelet counts were 393 × 103/mm3, with a mean peak (695 × 103/mm3) occurring an average of 13 days after initiation of therapy. All patients had resolution within 7 days after therapy. The maximum peak (1056 × 103/mm3) was observed in a patient after 14 days of antifungal therapy. The onset of thrombocytosis in this patient was 4 days and lasted 4 days after therapy. CONCLUSIONS Reactive thrombocytosis occurs during treatment of candidemia. The causative agent (drug vs disease), the risk associated with this reaction, and evaluation of treatment need to be elucidated by a larger epidemiologic study or controlled, prospective clinical trial.

scholarly journals 2016 guidelines for the use of antifungal agents in patients with invasive fungal diseases in Taiwan

2018 ◽  
Vol 51 (1) ◽  
pp. 1-17 ◽  
Author(s):  
Hsiang-Chi Kung ◽  
Po-Yen Huang ◽  
Wei-Ting Chen ◽  
Bor-Sheng Ko ◽  
Yee-Chun Chen ◽  
...  
Keyword(s):  
Antifungal Agents ◽  
Fungal Diseases ◽  
Invasive Fungal Diseases

Natural Products, for Fungal Diseases Management and Prevention

2021 ◽  
Vol 11 ◽  
Author(s):  
Nahid Akhtar ◽  
Rabia Ayoubi ◽  
Vinaypreet Kour ◽  
Umesh Goutam ◽  
M. Amin-ul Mannan
Keyword(s):  
Public Health ◽  
Side Effects ◽  
Antifungal Agents ◽  
Fungal Species ◽  
Antifungal Drugs ◽  
Fungal Diseases ◽  
Naturally Occurring ◽  
Invasive Fungal Diseases ◽  
Emergence Of Resistance

Abstract: Fungal diseases cause more deaths as compared to combined deaths due to malaria and tuberculosis. There are around 3.8 million fungal species, but only about 300 of them are pathogenic to humans. Invasive fungal diseases are majorly caused by Aspergillus, Candida, Cryptococcus, Histoplasma, Mucorales, and Pneumocystis. It has been estimated that around 1.5 million people die because of these infections across the globe. The emergence of resistance against the major classes of antifungal drugs poses a serious threat to public health. Moreover, the commonly used antifungal drugs are loaded with side effects. Some of them are nephrotoxic, hepatotoxic, cause cardiomyopathy, and in acute cases, cytotoxicity. Hence, it is important to seek novel molecules that can be safe and effective antifungal drugs. Naturally occurring molecules in plants and various microorganisms can be a safe and effective alternative to the existing antifungal drugs. In this review, the role of various phytochemicals such as alkaloids, flavonoids, saponins, and phenols as potential antifungal agents has been discussed. Similarly, naturally occurring molecules in other microorganisms like algae, bacteria, and various other fungi have been summarized. The information discussed in this review can be useful in the identification of novel antifungals.

scholarly journals Antifungal Agents for the Treatment of Systemic Fungal Infections in Children

2010 ◽  
Vol 21 (4) ◽  
pp. e116-e121 ◽  
Author(s):  
UD Allen
Keyword(s):  
Combination Therapy ◽  
Amphotericin B ◽  
Antifungal Therapy ◽  
Antifungal Agents ◽  
Fungal Infections ◽  
Invasive Pulmonary Aspergillosis ◽  
Fungal Diseases ◽  
Pulmonary Aspergillosis ◽  
Amphotericin B Deoxycholate ◽  
Systemic Antifungal Therapy

Traditionally, the mainstay of systemic antifungal therapy has been amphotericin B deoxycholate (conventional amphotericin B). Newer agents have been developed to fulfill special niches and to compete with conventional amphotericin B by virtue of having more favourable toxicity profiles. Some agents have displaced conventional amphotericin B for the treatment of specific fungal diseases. For example, voriconazole has emerged as the preferred treatment for invasive pulmonary aspergillosis. This notwithstanding, conventional amphotericin B remains a useful agent for the treatment of paediatric fungal infections. Knowledge of the characteristics of the newer agents is important, given the increasing numbers of patients who are being treated with these drugs. Efforts need to be directed at research aimed at generating paediatric data where these are lacking. The antifungal agents herein described are most often used as monotherapy regimens because there is no uniform consensus on the value of combination therapy, except for specific scenarios.

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