Optimizing antifungal choice and administration

Andes, David

doi:10.1185/03007995.2012.761135

Cited by 63Antifungal resistance and susceptibilityFungal Infections and StudiesOcular Infections and Treatments

Optimizing antifungal choice and administration

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Andes, David·2013·Current Medical Research and Opinion

DOI 10.1185/03007995.2012.761135

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Abstract

BACKGROUND: The antifungal armamentarium includes a number of drug classes and agents within each class. Successful IFI management depends on optimal matching of drug choice with the individual patient and causative pathogen, and maximizing effectiveness of the selected drug through appropriate dosing and toxicity management. OBJECTIVE: This review is intended to provide a brief overview of key factors involved in optimizing antifungal choice and administration for patients with invasive fungal infections (IFIs). FINDINGS: Antifungals differ in spectrum of activity, and these differences are critical when selecting the antifungal most likely to provide success for a patient with an IFI. When the species has not yet been identified, an analysis of regional epidemiology and risk factors can provide clues as to the most likely pathogen. For severely immunocompromised patients, a fungicidal agent may be preferred over a fungistatic agent, although more research is needed in this area. Triazoles, particularly itraconazole and posaconazole, exhibit great interpatient pharmacokinetic variability related to absorption. Steps can be taken to maximize absorption when using these agents. Voriconazole concentration is affected by polymorphisms in the major metabolic enzyme, cytochrome P450 2C19. Triazoles, and to a lesser extent other antifungals, are also subject to drug-drug interactions, which needs to be considered when selecting a particular antifungal agent for use in a severely ill patient on polypharmacy. Therapeutic drug monitoring may be a useful adjunct for patients receiving itraconazole, voriconazole, or posaconazole. When the IFI involves a pharmacologically protected site, such as the central nervous system (CNS) or eye, 5-fluorocytosine, fluconazole, or voriconazole are generally preferred. Echinocandin penetration is typically inadequate for IFIs of the CNS or eye. Antifungal agents also differ in their toxicity profiles, and these issues also need to be considered and managed when making an antifungal choice. CONCLUSION: Successful management of IFIs relies in part on the accurate selection of an antifungal agent for the infection. Drug characteristics can help in the selection of drug therapy. These characteristics include the drug's spectrum of activity, pharmacokinetics, pharmacodynamics, toxicity profile, and distribution to the infection site. Matching the drug profile to the patient and fungal species contribute to optimal management of infection.

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Fungicidal therapeutics are expected to improve the clinical outcome of invasive Candida infections, especially in patients with compromised immune systems.
“fungicidal therapeutics are expected to improve the clinical outcome of invasive Candida infections, especially in patients with compromised immune systems [47,48].”
From Aprepitant, an antiemetic agent, interferes with metal ion homeostasis ofCandida aurisand displays potent synergistic interactions with azole drugs (2020) · cites this paper as [47]

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Review Optimizing antifungal choice and administration
Andes, D. R. (2013)
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Authors: Andes, D.
Affiliations: University of Wisconsin–Madison (US)
Corresponding author: Andes, David
ORCID: Andes, David
Venue: Current Medical Research and Opinion
Publisher: Informa UK Limited
Published: 2013-04
Volume: 29
Issue: sup4
Pages: 13-18
ISSN: 0300-7995 (ISSN-L)
1473-4877
DOI: 10.1185/03007995.2012.761135
OpenAlex: W1982268275
Cited by: 63
References: 76
Citations by year: 2026: 2 · 2024: 1 · 2023: 3 · 2022: 3 · 2021: 5 · 2020: 4 · 2019: 3 · 2018: 6 · 2017: 8 · 2016: 9 · 2015: 10 · 2014: 7 · 2013: 2
FWCI: 1.20
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Current Medical Research and Opinion (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
Health Sciences › Medicine › Epidemiology › Fungal Infections and Studies
Health Sciences › Medicine › Ophthalmology › Ocular Infections and Treatments
Keywords: invasive fungal infections, antifungal agents, antifungal dosing, triazoles, voriconazole, itraconazole, posaconazole, echinocandins, drug-drug interactions, CYP2C19, pharmacokinetic variability, therapeutic drug monitoring, immunocompromised patients, antifungal toxicity, fungal eye infection, fluconazole, 5-fluorocytosine
MeSH terms: Antifungal Agents, Aryl Hydrocarbon Hydroxylases, Central Nervous System, Humans, Intestinal Absorption, Mycoses, Polymorphism, Genetic, Critical Illness, Drug Monitoring, Cytochrome P-450 CYP2C19

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