Tolerability and safety of antifungal drugs
DOI:
https://doi.org/10.7175/rhc.v4i2S.873Keywords:
Antifungals, Tolerability, SafetyAbstract
When treating critically ill patients, as those with fungal infections, attention should be focused on the appropriate use of drugs, especially in terms of dose, safety, and tolerability. The fungal infection itself and the concomitant physiological disorders concur to increase the risk of mortality in these patients, therefore the use of any antifungal agent should be carefully evaluated, considering both the direct action on the target fungus and the adverse effects eventually caused. Among antifungal drugs, echinocandins have the greatest tolerability. In fact, unlike amphotericin B, showing nephrotoxicity, and azoles, which are hepatotoxic, the use of echinocandins doesn’t result in major adverse events.
References
Takemoto K, Yamamoto Y, Ueda Y, et al. Comparative studies on the efficacy of AmBisome and Fungizone in a mouse model of disseminated aspergillosis. J Antimicrob Chemother 2004; 53: 311-7; http://dx.doi.org/10.1093/jac/dkh055
Cornely OA, Maertens J, Bresnik M, et al. Liposomal amphotericin B as initial therapy for invasive mold infection: a randomized trial comparing a high-loading dose regimen with standard dosing (AmBiLoad trial). Clin Infect Dis 2007; 44: 1289-97; http://dx.doi.org/10.1086/514341
Maertens JA. History of the development of azole derivatives. Clin Microbiol Infect 2004; 10 Suppl 1: 1-10; http://dx.doi.org/10.1111/j.1470-9465.2004.00841.x
Krishna G, Moton A, Ma L, et al. Pharmacokinetics and absorption of posaconazole oral suspension under various gastric conditions in healthy volunteers. Antimicrob Agents Chemother 2009; 53: 958-66; http://dx.doi.org/10.1128/AAC.01034-08
Chen SC, Slavin MA, Sorrell TC. Echinocandin antifungal drugs in fungal infections: a comparison. Drugs 2011; 71: 11-41; http://dx.doi.org/10.2165/11585270-000000000-00000
Wang JL, Chang CH, Young-Xu Y, et al. Systematic review and meta-analysis of the tolerability and hepatotoxicity of antifungals in empirical and definitive therapy for invasive fungal infection. Antimicrob Agents Chemother 2010; 54: 2409-19; http://dx.doi.org/10.1128/AAC.01657-09
Mills EJ, Perri D, Cooper C, et al. Antifungal treatment for invasive Candida infections: a mixed treatment comparison meta-analysis. Ann Clin Microbiol Antimicrob 2009; 8:23; http://dx.doi.org/10.1186/1476-0711-8-23
EMA. Evaluation of Medicines for Human Use. Assessment report for Mycamine. Available via URL: http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Public_assessment_report/human/000734/WC500031079.pdf
RCP Ecalta. Available via URL: http://www.ema.europa.eu/docs/it_IT/document_library/EPAR_-_Product_Information/human/000788/WC500020673.pdf
RCP Cancidas. Available via URL: http://www.ema.europa.eu/docs/it_IT/document_library/EPAR_-_Product_Information/human/000379/WC500021033.pdf
Published
Issue
Section
License
Authors who publish with this journal agree to the following terms:- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial 4.0 License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal. The Publication Agreement can be downloaded here, and should be signed by the Authors and sent to the Publisher when the article has been accepted for publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
- Authors are permitted to post their work online after publication (the article must link to publisher version, in html format)