Empiric anti-Candida therapy for patients with sepsis in the ICU: how little is too little?
Prior analyses suggest that empiric fluconazole for ICU patients with sepsis is cost-effective. Using updated estimates of efficacy and cost, Zilberberg and colleagues compare the use of micafungin with that of fluconazole. The authors conclude that micafungin is an attractive alternative to fluconazole. This conclusion is driven by recent reduction in micafungin's cost and by better activity of micafungin against azole-resistant Candida species. Their results are limited by inflated estimates of efficacy, life expectancy and risk of Candida sepsis. This commentary explores the rationale for early anti-Candida strategies in the ICU and highlights the contribution and limitations of the article by Zilberberg and colleagues.
Golan
Yoav
Y
Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA. ygolan@tuftsmedicalcenter.org
D000935:Antifungal Agents / Q000494:pharmacology / Q000627:therapeutic use; D002175:Candida / Q000187:drug effects*; D002177:Candidiasis / Q000188:drug therapy*; D002985:Clinical Protocols; D054714:Echinocandins / Q000494:pharmacology / Q000627:therapeutic use; D015725:Fluconazole / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D007362:Intensive Care Units; D055666:Lipopeptides / Q000494:pharmacology / Q000627:therapeutic use; D000077551:Micafungin; D018805:Sepsis / Q000188:drug therapy*
D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D015725:Fluconazole; D000077551:Micafungin