Autor segons l'article: Maseda, Emilio; Martin-Loeches, Ignacio; Zaragoza, Rafael; Peman, Javier; Fortun, Jesus; Grau, Santiago; Aguilar, Gerardo; Varela, Marina; Borges, Marcio; Gimenez, Maria-Jose; Rodriguez, Alejandro
Departament: Ciències Mèdiques Bàsiques
Autor/s de la URV: Rodríguez Oviedo, Alejandro Hugo
Paraules clau: United-states; Pk/pd; Pharmacokinetic; Liposomal amphotericin-b; Liposomal amphotericin b; Invasive candidiasis; Intraabdominal penetration; Intraabdominal candidiasis; Ill patients; Humans; Guidelines; Fungal-infections; Echinocandins; Echinocandin resistance; Decision algorithm; Consensus guidelines; Candidiasis, invasive; Candidemia; Antifungal therapy; Antifungal stewardship; Antifungal stewardshi; Antifungal agents; Abdominal candidiasis
Resum: BackgroundRegardless of the available antifungals, intraabdominal candidiasis (IAC) mortality continues to be high and represents a challenge for clinicians.Main bodyThis opinion paper discusses alternative antifungal options for treating IAC. This clinical entity should be addressed separately from candidemia due to the peculiarity of the required penetration of antifungals into the peritoneal cavity. Intraabdominal concentrations may be further restricted in critically ill patients where pathophysiological facts alter normal drug distribution. Echinocandins are recommended as first-line treatment in guidelines for invasive candidiasis. However, considering published data, our pharmacodynamic analysis suggests the required increase of doses, postulated by some authors, to attain adequate pharmacokinetic (PK) levels in peritoneal fluid. Given the limited evidence in the literature on PK/PD-based treatments of IAC, an algorithm is proposed to guide antifungal treatment. Liposomal amphotericin B is advocated as first-line therapy in patients with sepsis/septic shock presenting candidemia or endophthalmitis, or with prior exposure to echinocandins and/or fluconazole, or with infections by Candida glabrata. Other situations and alternatives, such as new compounds or combination therapy, are also analysed.ConclusionThere is a critical need for more robust clinical trials, studies examining patient heterogeneity and surveillance of antifungal resistance to enhance patient care and optimise treatment outcomes. Such evidence will help refine the existing guidelines and contribute to a more personalised and effective approach to treating this serious medical condition. Meanwhile, it is suggested to broaden the consideration of other options, such as liposomal amphotericin B, as first-line treatment until the results of the fungogram are available and antifungal stewardship could be implemented to prevent the development of resistance.
Àrees temàtiques: Saúde coletiva; Nutrição; Medicina veterinaria; Medicina iii; Medicina ii; Medicina i; Interdisciplinar; Farmacia; Engenharias iv; Enfermagem; Educação física; Critical care medicine; Critical care and intensive care medicine; Ciências biológicas iii; Ciências biológicas ii; Ciências biológicas i; Ciência de alimentos; Biotecnología
Accès a la llicència d'ús: https://creativecommons.org/licenses/by/3.0/es/
Adreça de correu electrònic de l'autor: alejandrohugo.rodriguez@urv.cat
Data d'alta del registre: 2025-01-27
Versió de l'article dipositat: info:eu-repo/semantics/publishedVersion
Enllaç font original: https://ccforum.biomedcentral.com/articles/10.1186/s13054-023-04673-6
Referència a l'article segons font original: Critical Care. 27 (1): 382-
Referència de l'ítem segons les normes APA: Maseda, Emilio; Martin-Loeches, Ignacio; Zaragoza, Rafael; Peman, Javier; Fortun, Jesus; Grau, Santiago; Aguilar, Gerardo; Varela, Marina; Borges, Mar (2023). Critical appraisal beyond clinical guidelines for intraabdominal candidiasis. Critical Care, 27(1), 382-. DOI: 10.1186/s13054-023-04673-6
URL Document de llicència: https://repositori.urv.cat/ca/proteccio-de-dades/
DOI de l'article: 10.1186/s13054-023-04673-6
Entitat: Universitat Rovira i Virgili
Any de publicació de la revista: 2023
Tipus de publicació: Journal Publications
Repositori URV