title: Using pharmacokinetics and pharmacodynamics to optimise dosing of antifungal agents in critically ill patients: a systematic review.
abstract: The prevalence of invasive fungal infections (IFIs) caused by Candida spp. is increasing in critically ill patients. Recent development of new antifungal agents has significantly contributed to the successful treatment of IFIs. However, the pharmacokinetics of antifungal agents can be altered in a number of disease states, including critical illness. Therefore, doses established in healthy volunteers and other patient groups may not be appropriate for the critically ill. Moreover, inadequate dosing may contribute to treatment failure and the emergence of resistance. This systematic review provides a critical analysis of the pharmacokinetics of antifungal agents in the critically ill and their relevance to dosing requirements in clinical practice. Based on the limited data available, dosing of some antifungal agents may have to be adjusted in critically ill patients with conserved renal function as well as in those requiring renal replacement therapy. Further research to confirm the appropriateness of current dosing strategies to attain the appropriate pharmacodynamic targets is recommended.
authors.affiliation: Pharmacy Department, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville, Adelaide, SA 5011, Australia. Mahipal.Sinnollareddy@health.sa.gov.au
authors.forename: Mahipal
authors.initials: M
authors.lastname: Sinnollareddy
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Peake
authors.forename: Michael S
authors.initials: MS
authors.lastname: Roberts
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Lipman
authors.forename: Jason A
authors.initials: JA
authors.lastname: Roberts
mesh_terms: D000935:Antifungal Agents / Q000008:administration & dosage / Q000493:pharmacokinetics* / Q000627:therapeutic use*; D002175:Candida / Q000145:classification / Q000187:drug effects; D002177:Candidiasis / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D016638:Critical Illness; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D006801:Humans; D007677:Kidney Function Tests; D017582:Renal Replacement Therapy
chemical_list: D000935:Antifungal Agents