Atualização no uso de agentes antifúngicos

Abstract

We summarize here data regarding the spectrum of action, the pharmacological aspects, the toxicological aspects and the clinical efficacy of liposomal amphotericin B, amphotericin B in colloidal dispersion, amphotericin B lipid complex, voriconazole and caspofungin. We discuss the use of these more recently introduced antifungal agents in terms of their safety, efficiency and cost. We also offer suggestions for the clinical use of these drugs in pulmonary and systemic infections, with an emphasis on the lower toxicity of the lipid formulations of amphotericin B in comparison with conventional medications. In addition, we explore the possibility of using voriconazole as the primary treatment for invasive infections such as aspergillosis, as well as those caused by Scedosporium spp. and Fusarium spp., together with that of using caspofungin to treat disseminated candidiasis and invasive aspergillosis.

Concentração de cálcio no dialisato e hipercalcemia na DRC

“…27 Nephrotoxicity is the most common adverse effect of AB, and it is aggravated when there is already some degree of renal impairment. The main nephrotoxic mechanism is the increase of afferent arteriole resistance and/or tubular permeability.…”

Antifúngicos em infecções oculares: drogas e vias de administração

“…Isolated in the 1950s, AMB is produced by the actinomycete Streptomyces nodosus. It became popular after approval by the FDA in the 1960s due to its great efficiency in controlling disseminated fungal infections (4,(6)(7)(8) . In ophthalmology, it is still the reference drug.…”

“…It also binds to cholesterol in human cells, which is the main reason for its side effects (8,9) . The drug's name is derived from its amphoteric properties (soluble in extreme pHs, both acidic and basic).…”

“…It always causes tubular injury with loss of kidney function in patients with previous kidney disease. It is also partly eliminated by the liver (8,11,12) . AMB should not be diluted in saline solution, as aggregation of colloids can occur, thus reducing the drug's bioavailability.…”

“…Compared to AMB, they have a broader spectrum of action and cause fewer adverse effects. Their use spread rapidly, especially in the treatment of infections of the skin and mucous membranes (8) . Azoles act on fungal cytochrome P450 enzymes by blocking the synthesis of ergosterol in the plasma membrane, thus inhibiting fungal growth.…”