Canbay A E, Glöckner A
Universitätsklinikum Essen, Essen, Deutschland.
Med Klin Intensivmed Notfmed. 2015 Apr;110(2):138-44. doi: 10.1007/s00063-013-0262-y. Epub 2013 Jun 26.
Liver dysfunction is common among patients on intensive care units (ICU) due to sepsis, chronic liver disease, ischemic hepatitis, drug toxicity and intensive care measures. Critically ill patients with invasive fungal infections should therefore be treated with antifungals that are not metabolized by the liver. This may help to avoid therapeutic complications by drug accumulation, inadequate dosages or drug-drug interactions. Echinocandins are established as the antifungal class of choice in the treatment of invasive Candida infections. Anidulafungin is not hepatically metabolized and may be used without dose adjustments in patients with severe liver dysfunction. It has no known clinically relevant drug interactions. In the primary endpoint of the randomized pivotal trial in patients with candidemia or invasive candidiasis, anidulafungin was statistically superior versus the former standard therapy (fluconazole), with a favourable overall safety profile. More recent study data particularly in ICU patients confirm the efficacy of anidulafungin for these patient groups. Therefore, anidulafungin is an important antifungal treatment option for patients with liver dysfunction.
由于脓毒症、慢性肝病、缺血性肝炎、药物毒性及重症监护措施等原因，肝功能障碍在重症监护病房（ICU）患者中很常见。因此，患有侵袭性真菌感染的重症患者应使用不经肝脏代谢的抗真菌药物进行治疗。这可能有助于避免因药物蓄积、剂量不足或药物相互作用而导致的治疗并发症。棘白菌素类已被确立为治疗侵袭性念珠菌感染的首选抗真菌药物类别。阿尼芬净不经肝脏代谢，在严重肝功能障碍患者中使用时无需调整剂量。它没有已知的临床相关药物相互作用。在念珠菌血症或侵袭性念珠菌病患者的随机关键试验的主要终点方面，阿尼芬净在统计学上优于先前的标准疗法（氟康唑），且总体安全性良好。尤其是最近在ICU患者中的研究数据证实了阿尼芬净对这些患者群体的疗效。因此，阿尼芬净是肝功能障碍患者重要的抗真菌治疗选择。
