[Therapy of candidemia and invasive candidiasis according to guidelines].
Invasive fungal infections on the intensive care unit are predominantly caused by Candida spp., most frequently manifesting as candidemia. In spite of increasing treatment options during the last two decades, mortality of invasive candidiasis remains high with 20 to 50%. With the echinocandins, a new class of antifungal drugs with activity against clinically relevant Aspergillus and Candida spp. has become available since the beginning of the new millennium. The echinocandins have shown convincing efficacy in numerous multicentre, mostly double-blinded clinical trials. These trials compared current standard treatment regimens with the echinocandins anidulafungin, caspofungin, and micafungin. All trials observed non-inferiority of the new drugs against the standard treatment; in the case of anidulafungin, superiority against fluconazole was demonstrated. These results of the trials had resulted in modification of the current guidelines for the treatment of candidemia and invasive candidiasis. Especially in ICU patients frequently showing single- or multi-organ failure and receiving a multitude of drugs with complex interactions, echinocandins have become the treatment of first choice for candidemia.
Glöckner
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BDH-Klinik Greifswald GmbH, Greifswald, Deutschland. a.gloeckner@bdh-klinik-greifswald.de
D000935:Antifungal Agents / Q000627:therapeutic use*; D001393:Azoles / Q000627:therapeutic use; D002177:Candidiasis / Q000188:drug therapy*; D054714:Echinocandins / Q000627:therapeutic use; D016469:Fungemia / Q000188:drug therapy*; D006801:Humans; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic
D000935:Antifungal Agents; D001393:Azoles; D054714:Echinocandins