Antifungal Dosing Strategies for Critically Ill Patients

Diagnosis and management of invasive fungal diseases in non-neutropenic ICU patients, with focus on candidiasis and aspergillosis: a comprehensive review

“…These changes are attributed to gastrointestinal dysfunction causing unpredictable drug absorption, changes in fluid status, protein binding, volume of distribution, and changes in hepatic and renal function, causing altered metabolism and drug clearance (see Figure 2 ). Given these complexities, it is essential to consider individual patients’ clinical status, organ function and pharmacokinetic/pharmacodynamic alterations when prescribing antifungal medications ( Dietrich et al., 2017 ; Abdul–Aziz et al., 2020 ).…”

Pharmacokinetics of Fluconazole tablets administered to healthy subjects ‎

“…The rapid and high absorption after oral administration of fluconazole, in addition to the relatively high apparent volume of distribution, and long terminal plasma elimination half-life and mean residence times, make the drug effective at a wide range of body sites [3,4,11]. Using antimicrobial agents for prevention and treatment of infections possesses special concern for successful therapy to get the necessary therapeutic plasma concertation with optimal effect and minimal adverse effect [12,15,[18][19][20]. If the administered antimicrobial dose yield plasma levels below the minimum therapeutic levels and consequently it is not adequate to produce the required efficacious plasma levels which assure destruction of the microorganism which causes the infection, then this will lead to the failure of drug therapy and the infection will persist, and the potential risk for developing resistance to the drug may be escalated.…”

“…If the administered antimicrobial dose yield plasma levels below the minimum therapeutic levels and consequently it is not adequate to produce the required efficacious plasma levels which assure destruction of the microorganism which causes the infection, then this will lead to the failure of drug therapy and the infection will persist, and the potential risk for developing resistance to the drug may be escalated. On the other extreme, If the given dose of the antimicrobial agent yields plasma levels above the maximum therapeutic levels, consequently drug therapy will be associated with adverse effect(s) which lead to stopping the drug usage, and replacement by other antimicrobial, or using a combination of antimicrobial agents which have many negative sides in term of the health and cost to the patient [12,15,[18][19][20]. Therefore, many pharmacokinetics, bioavailability, and bioequivalence researches were conducted in different countries and for almost all drugs to know the pharmacokinetic behaviors of the drug in each nation [12][13][14][15][16][17][18][21][22][23][24][25][26][27][28][29].…”