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.

Chatelon J., Cortegiani A., Hammad E., Cassir N., Leone M. (2019). Choosing the Right Antifungal Agent in ICU Patients. ADVANCES IN THERAPY, 36(12), 3308-3320 [10.1007/s12325-019-01115-0].

Choosing the Right Antifungal Agent in ICU Patients

Cortegiani A.;
2019-01-01

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.
2019
Chatelon J., Cortegiani A., Hammad E., Cassir N., Leone M. (2019). Choosing the Right Antifungal Agent in ICU Patients. ADVANCES IN THERAPY, 36(12), 3308-3320 [10.1007/s12325-019-01115-0].
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10447/385468
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