Candidemia in the Intensive Care Unit
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Keywords:
Echinocandins
Invasive candidiasis
Antifungal drugs
Antifungal drugs
Fungal infections have shown an upsurge in recent decades, which is mainly because of the increasing number of immunocompromised patients and the occurrence of invasive candidiasis has been found to be 7-15 fold greater than that of invasive aspergillosis. The genus Candida comprises more than 150 distinct species, however, only a few of them are found to be pathogenic to humans. Mortality rates of Candida species are found to be around 45% and the reasons for this intensified mortality are inefficient diagnostic techniques and unfitting initial treatment strategies. There are only a few antifungal drug classes that are employed for the remedy of invasive fungal infections. which include azoles, polyenes, echinocandins, and pyrimidine analogs. During the last 2-3 decades, the usage of antifungal drugs has increased several folds due to which the reports of escalating antifungal drug resistance have also been recorded. The resistance is mostly to the triazole- based compounds. Due to the occurrence of antifungal drug resistance, the success rates of treatment have been reduced as well as major changes have been observed in the frequency of fungal infections. In this review, we have summarized the major molecular mechanisms for the development of antifungal drug resistance.
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In immunocompromised hosts, invasive fungal infections are common and fatal. In the past decade, the antifungal armamentarium against invasive mycoses has expanded greatly. The purpose of the present report is to review the most recent literature addressing the use of antifungal agents in children.Most studies evaluating the safety and efficacy of antifungal agents are limited to adults. However, important progress has been made in describing the pharmacokinetics and safety of newer antifungal agents in children, including the echinocandins.Dosage guidelines for newer antifungal agents are currently based on adult and limited pediatric data. Because important developmental pharmacology changes occur throughout childhood impacting the pharmacokinetics of these agents, antifungal studies specifically designed for children are necessary.
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The research of antifungal drugs were summarized with respect to new fourmulations and chemical modifications of existing drugs,new antifungal target and new drug screening,with emphasis on the progress of β-1,3-D-glucan synthase inhibitor and new antifungal target discovery.Current problem and tendency in research on antifungal drugs were discussed.
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OBJECTIVE: To introduce the study progress and clinical application on antifungal drugs. METHODS: By analyzing the literature about the antifungal drugs at home and abroad, study progress and clinical application on antifungal drugs were reviewed by classification. RESULTS CONCLUTION: The study on the antifungal drugs is mainly concentrated on the structure reform and the discoveries of new antifungal drugs. In clinical, the antifungal drugs are being used according to its different characteristic.
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Antifungal pharmacokinetics and pharmacodynamics (PK–PD) has been used to develop currently available antifungal agents, and further optimize their use for critically ill patients. New experimental models have been developed to enable drug concentration–effect relationships to be characterized. This chapter describes the tools that have been developed and are available for antifungal PK–PD. The PK–PD of currently available antifungal drug classes and agents within those classes are reviewed. As knowledge improves, antifungal PK–PD will become a critical component for the development of new agents.
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Candida is a major pathogen responsible for deep fungal infections.The extensive use of antifungal agents has resulted in Candida having serious resistance to these antifungal drugs.This review describes advances in the study of the mechanisms by which Candida develops resistance to commonly used antifungal agents such as azoles,polyenes,and echinocandins in order to provide a theoretical basis for further research on the mechanism of Candida's drug resistance and to guide the rational use of antifungal agents.
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Echinocandins
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