Fluconazole therapy for treatment of invasive candidiasis in Intensive Care patients. Is it still valid from a pharmacological point of view?
Fluconazole – antimycotic belonging to the first generation azoles – is widely used as treatment for invasive candidiasis and candidemia in numerous clinical settings as Neonatal Intensive Care Unit (NICU) and adult Intensive Care Unit (ICU), as well as oncology, onco-hematology and solid organ tran...
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| Format: | Article |
| Language: | English |
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Hygeia Press di Corridori Marinella
2014-03-01
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| Series: | Journal of Pediatric and Neonatal Individualized Medicine |
| Subjects: | |
| Online Access: | https://www.jpnim.com/index.php/jpnim/article/view/133 |
| _version_ | 1828454179248537600 |
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| author | Mario Musu Maurizio Evangelista Paolo Mura Andrea Cossu Massimiliano Carta Gian Nicola Aru Gabriele Finco |
| author_facet | Mario Musu Maurizio Evangelista Paolo Mura Andrea Cossu Massimiliano Carta Gian Nicola Aru Gabriele Finco |
| author_sort | Mario Musu |
| collection | DOAJ |
| description | Fluconazole – antimycotic belonging to the first generation azoles – is widely used as treatment for invasive candidiasis and candidemia in numerous clinical settings as Neonatal Intensive Care Unit (NICU) and adult Intensive Care Unit (ICU), as well as oncology, onco-hematology and solid organ transplantation. More recently use of antimycotics has spread to medical divisions, where fungal infections represent an emerging problem due to population’s ageing, malnourishment and important comorbidities. Fluconazole is effective against numerous Candida species, particularly against albicans, tropicalis and parapsilosis strains. On the other hand, C. krusei is intrinsically resistant to fluconazole and C. glabrata can be sensitive or resistant in a dose dependent fashion. Epidemiological variability is noteworthy and depends on the geographical location of the institution, the clinical setting, and the frequency and intensity of fluconazole employment for invasive candidiasis. In many ICUs fluconazole sensitive C. albicans is cultured in 50% of positive samples, while the remaining 50% show growth of variably sensitive fungal species, often resistant to fluconazole. Due to increasingly frequent emergence of resistant strains of Candida spp., American guidelines (IDSA) in 2009, and European ones (ESCMID) in 2012, recommended substitution of fluconazole with echinocandines as first line therapy in patients with severe disease, as defined by an APACHE II score greater than 15. Thus fluconazole must be limited to low risk cases, treatment of sensitive strains and de-escalation from echinocandin therapy, after microbiological diagnosis and drug resistance profile characterization. |
| first_indexed | 2024-12-11T00:17:33Z |
| format | Article |
| id | doaj.art-08b07f001f1b4fa8a7b85f5b65f23422 |
| institution | Directory Open Access Journal |
| issn | 2281-0692 |
| language | English |
| last_indexed | 2024-12-11T00:17:33Z |
| publishDate | 2014-03-01 |
| publisher | Hygeia Press di Corridori Marinella |
| record_format | Article |
| series | Journal of Pediatric and Neonatal Individualized Medicine |
| spelling | doaj.art-08b07f001f1b4fa8a7b85f5b65f234222022-12-22T01:27:52ZengHygeia Press di Corridori MarinellaJournal of Pediatric and Neonatal Individualized Medicine2281-06922014-03-0131e030120e03012010.7363/030120103Fluconazole therapy for treatment of invasive candidiasis in Intensive Care patients. Is it still valid from a pharmacological point of view?Mario Musu0Maurizio Evangelista1Paolo Mura2Andrea Cossu3Massimiliano Carta4Gian Nicola Aru5Gabriele Finco6Department of Medical Sciences “M. Aresu”, University of Cagliari, CagliariDepartment of Emergency, Catholic University of the Sacred Heart, RomeDepartment of Medical Sciences “M. Aresu”, University of Cagliari, CagliariDepartment of Medical Sciences “M. Aresu”, University of Cagliari, CagliariDepartment of Medical Sciences “M. Aresu”, University of Cagliari, CagliariDepartment of Medical Sciences “M. Aresu”, University of Cagliari, CagliariDepartment of Medical Sciences “M. Aresu”, University of Cagliari, CagliariFluconazole – antimycotic belonging to the first generation azoles – is widely used as treatment for invasive candidiasis and candidemia in numerous clinical settings as Neonatal Intensive Care Unit (NICU) and adult Intensive Care Unit (ICU), as well as oncology, onco-hematology and solid organ transplantation. More recently use of antimycotics has spread to medical divisions, where fungal infections represent an emerging problem due to population’s ageing, malnourishment and important comorbidities. Fluconazole is effective against numerous Candida species, particularly against albicans, tropicalis and parapsilosis strains. On the other hand, C. krusei is intrinsically resistant to fluconazole and C. glabrata can be sensitive or resistant in a dose dependent fashion. Epidemiological variability is noteworthy and depends on the geographical location of the institution, the clinical setting, and the frequency and intensity of fluconazole employment for invasive candidiasis. In many ICUs fluconazole sensitive C. albicans is cultured in 50% of positive samples, while the remaining 50% show growth of variably sensitive fungal species, often resistant to fluconazole. Due to increasingly frequent emergence of resistant strains of Candida spp., American guidelines (IDSA) in 2009, and European ones (ESCMID) in 2012, recommended substitution of fluconazole with echinocandines as first line therapy in patients with severe disease, as defined by an APACHE II score greater than 15. Thus fluconazole must be limited to low risk cases, treatment of sensitive strains and de-escalation from echinocandin therapy, after microbiological diagnosis and drug resistance profile characterization.https://www.jpnim.com/index.php/jpnim/article/view/133fluconazoleinvasive candidiasisicuapache ii scoresensitivityresistance |
| spellingShingle | Mario Musu Maurizio Evangelista Paolo Mura Andrea Cossu Massimiliano Carta Gian Nicola Aru Gabriele Finco Fluconazole therapy for treatment of invasive candidiasis in Intensive Care patients. Is it still valid from a pharmacological point of view? Journal of Pediatric and Neonatal Individualized Medicine fluconazole invasive candidiasis icu apache ii score sensitivity resistance |
| title | Fluconazole therapy for treatment of invasive candidiasis in Intensive Care patients. Is it still valid from a pharmacological point of view? |
| title_full | Fluconazole therapy for treatment of invasive candidiasis in Intensive Care patients. Is it still valid from a pharmacological point of view? |
| title_fullStr | Fluconazole therapy for treatment of invasive candidiasis in Intensive Care patients. Is it still valid from a pharmacological point of view? |
| title_full_unstemmed | Fluconazole therapy for treatment of invasive candidiasis in Intensive Care patients. Is it still valid from a pharmacological point of view? |
| title_short | Fluconazole therapy for treatment of invasive candidiasis in Intensive Care patients. Is it still valid from a pharmacological point of view? |
| title_sort | fluconazole therapy for treatment of invasive candidiasis in intensive care patients is it still valid from a pharmacological point of view |
| topic | fluconazole invasive candidiasis icu apache ii score sensitivity resistance |
| url | https://www.jpnim.com/index.php/jpnim/article/view/133 |
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