Newer Antifungal Agents: Scope of Clinical Misuse in Intensive Care Units

The objective of this review is to explore the reasons and to formulate the strategy for their use. Various reasons cited for misuse were the generally increasing incidence of resistant fungi as well as also the risk factors in critically-ill patients like indwelling lines and catheters, broad-spectrum antibiotic cover, hemodialysis, total parenteral nutrition, steroids, and mechanical ventilation. Newer antifungal agents recently available are the echinocandins such as caspofungin, micanozole, anidulafungin and posaconazole. These have approved indications for their use which should be strictly adhered to. There is a need for formulation of guidelines for initiating antifungal therapy as well as setting the dose and duration of therapy for approved indications and de-escalating including review and stoppage of antifungals if not required. Not much choice is available besides amphotericin B, itraconazole and posaconazole with fungi like mucor. Abuse of these should be totally abolished.
Source: Journal of Patient Safety and Infection Control - Category: Infectious Diseases Source Type: research