Fungal infections Flashcards
Risk factors for invasive fungal infections
Immunocompromised
Local/environmental conditions
Echinocandin class drugs
caspofungin
anidulafungin
micafungin
Azole class drugs
fluconazole
voriconazole
others, end in azole
Polyene class drugs
Amphotericin B
Liposomal amphotericin
Amphotericin B BBWs
use primarily for treatment of progressive, potentially life-threatening fungal infections, not for non-invasive forms of infections
verify product name and dosage if dosage exceeds 1.5mg/kg
mechanism of drug interactions with azole antifungals
inhibit 3A4 and drug transporter P-glycoprotein. coadministration of these drugs and inducers of 3A4 can dramatically increase azole clearance, leading to ineffective treatment
candida albicans characteristics
most common fungal OI
most susceptible to commonly used antifungals
candida albicans primary treatment
fluconazole and other commonly used antifungals
Candida glabrata characteristics
common cause of both de novo candidemia in heavily immunocompromised hosts and breakthrough infection in patients on fluconazole prophylaxis
less virulent than other species
typically seen in pts with poor PS, so mortality is high
Candida glabrata primary treatment
Amp B or echinocandina should be considered until fluconazole susceptibility is established
Candida krusei characteristics
less common, and associated with breakthrough infections in heavily immunocompromised patients
should always be considered resistant to fluconazole!!
candida krusei treatment
susceptibility to itraconazole and voriconazole are usually retained.
NO FLUCONAZOLE
What patients should receive empiric therapy for invasive candidiasis?
patients with persistent, unexplained fever and host deficits that predispose patients to candidemia, including broad-spectrum antibacterial therapy, presence of central venous catheter, patients with severe organ dysfunction or on dialysis, patients with neutropenia or qualitative deficiencies in host immunity, or colonization with candida at one or more body sites
treatment for invasive candidiasis in a non-neutropenic, clinically stable patient
fluconazole 800mg/day for at least 2 weeks
longer for complicated infections
treatment for invasive candidiasis in critically ill patients with renal dysfunction, hypotension, sepsis, or facility with high rates of C. glabrata or C. krusei
echinocandins
