The Internet Book of Critical Care Podcast
IBCC Episode 98 - Antifungal Agents
Sep 14, 2020
The podcast discusses the approach to invasive fungal infections in critically ill patients. It covers the major classes of antifungal agents, their properties, and appropriate use in different scenarios. Topics include fluconazole, liposomal amphotericin, nephrotoxicity, drug-drug interactions, and ocular candidemia.
25:00
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Quick takeaways
- Echinocandins are effective antifungal agents for severe Candida infections in critically ill patients, especially those with indwelling devices.
- Voriconazole is a frontline therapy for invasive aspergillosis with excellent bioavailability and tissue penetration, but may not be optimal for mucormycosis.
Deep dives
Echinocandins are recommended as first-line treatment for critically ill patients with candidemia
Echinocandins, such as micafungin, caspofungin, and anidulafungin, are broad-spectrum antifungal agents that cover nearly all Candida species. They are fungicidal and penetrate biofilms, making them a suitable choice for critically ill patients with severe Candida infections, especially those with indwelling devices. Echinocandins have a favorable toxicity profile and are considered first-line therapy for invasive candidiasis. They are well-tolerated and relatively easy to use. Monitoring liver function tests is recommended during treatment.
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