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Antifungal Treatments in Critically Ill Patients

  • Marco Dei PoliEmail author
  • Giacomo Trevisan
  • Luca Di Girolamo
  • Gianluca Spinelli
Chapter

Abstract

Invasive fungal infections (IFI) in critically ill patients increase mortality. Despite this, issues regarding isolation of pathogens (lack of sensibility or diagnostic value of cultures, time-lapse required for results) imply some difficulties in the diagnosis.

Many risk factors are associated with IFI development. Clinical scores (Candida score, Nebraska Medical Center score) and biomarkers (beta-d-glucan) can help in the identification of these infections.

Given the fact that time and type of therapy are crucial to improve survival, it must be considered that critical illness often underlies conditions that significantly alter drugs’ pharmacokinetic/pharmacodynamic profile: hepatic or renal failure may affect drugs’ metabolism and elimination, and the frequent administration of multiple therapies to the patient increases the risk of pharmacological interactions. This makes antifungal’s plasmatic level variable and hardly predictable, conditioning both therapeutic effect and toxicity.

The main antifungals available for critical settings are echinocandins (caspofungin, micafungin, anidulafungin), azoles (fluconazole, voriconazole), and amphotericin B: their spectra of action, indications, and conditions that require dose adjustments are analyzed separately. A more “pharmacological view,” which takes into account variation in volume of distribution (Vd) of drugs in such settings, is likely to be necessary when managing critically ill patients with IFI, but a relatively poor state of knowledge has highlighted the need of more evidences in the pharmacology of antifungal drugs.

Keywords

Invasive fungal infections Echinocandins Azoles Amphotericin B Pharmacokinetics/pharmacodynamics 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Marco Dei Poli
    • 1
    Email author
  • Giacomo Trevisan
    • 2
  • Luca Di Girolamo
    • 2
  • Gianluca Spinelli
    • 2
  1. 1.Anesthesia and Intensive Care DepartmentIRCCS Policlinico San DonatoMilanItaly
  2. 2.Department of Medical Physiopathology and TransplantsUniversity of MilanMilanItaly

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