In this post, I link to and excerpt from Dr Farkas’ Internet Book of Critical Care of August 17, 2020, IBCC chapter & cast – Antifungal agents. August 24, 2020 [Link is to the podcast] [Link is to the show notes].*
*I like to remind readers that these excerpt posts are mostly my study aides to help me remember the topic. And posting the excerpt in my blog makes it easier to find topics using my blog’s search function or Categories list.
Here is Dr. Farkas’ introduction:
Fungal infections are becoming common among critically ill patients, as our patient population is increasingly complex and more frequently immunosuppressed. Traditional curricula often focus on antibacterial agents rather than antifungals, leaving antifungal agents shrouded in a sense of mystery. Antifungals actually aren’t that tricky though, as there is a very limited number of them.
I’ve embedded the podcast here:
And here are excerpts from the chapter:
- Amphotericin has a high rate of nephrotoxicity, so reserve this for situations where it is truly necessary.
- Azole antifungals are generally well tolerated, but are involved in numerous drug-drug interactions. Look carefully for interactions before initiating these (use a drug-interaction tool such as 🧮 MedScape’s drug interaction checker.)
- Echinocandins are excellent for candidemia, but they don’t penetrate the eye. For patients with ocular involvement, alternative treatment may be needed.
- For critically ill patients with a high likelihood of fungal infection, consider empiric initiation of therapy, prior to definitive diagnosis. Relatively nontoxic and broad-spectrum agents exist that can be initiated early, with a positive risk/benefit ratio.
What follows are the direct links to each section of Dr Farkas’ post and are also a great outline of the chapter.