Department of Experimental and Clinical Medical Sciences, University of Udine, Institute of Clinical Pharmacology, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, Udine, Italy +39 0432 559833 +39 0432 559819
Expert Rev Anti Infect Ther. 2013 Oct;11(10):989-97. doi: 10.1586/14787210.2013.836058. Epub 2013 Oct 4.
Candida infections represent challenging causes of severe sepsis and/or of septic shock in the critically ill patients. Knowledge of current pharmacological concepts may promote a more wise use of echinocandins in the management of Candida infections in this setting. Echinocandins have some advantages over azoles, both pharmacodynamically (rapid fungicidal activity, anti-biofilm activity, unmodified activity against Candida isolates with decreased susceptibility to azoles and anti-cytokine/anti-chemokine activity) and pharmacokinetically (low interindividual variability, low potential for drug-drug interactions), that may influence the timing and the choice of therapy of Candida diseases in the critically ill patients. However, concerns exist in regards to the feasibility of fixed dosing regimens of echinocandins in all of the different patient populations and in regards to the effectiveness of echinocandin monotherapy in some clinical settings. In presence of deep-seated infections, voriconazole or liposomal amphotericin B may be valuable alternatives or add-on therapy.
念珠菌感染是危重症患者发生严重脓毒症和/或感染性休克的棘手病因。了解当前药理学概念，有助于在该背景下明智地使用棘白菌素类药物治疗念珠菌感染。与唑类药物相比，棘白菌素类药物具有一些优势，包括药效学（快速杀菌活性、抗生物膜活性、对唑类药物敏感性降低的念珠菌分离株保持活性、抗细胞因子/趋化因子活性）和药代动力学（个体间变异性低、药物相互作用的潜力低），这可能会影响危重症患者念珠菌病的治疗时机和选择。然而，棘白菌素类药物在所有不同患者人群中采用固定剂量方案的可行性以及棘白菌素类药物单药治疗在某些临床环境中的疗效仍存在担忧。对于深部感染，伏立康唑或脂质体两性霉素 B 可能是有价值的替代药物或附加治疗药物。
