Antifungal Therapy

Septic patients not responding to conventional antibiotics should be evaluated for fungal infections. Candida albicans is the most common fungal species; however, the prevalence of nonalbicans species is increasing. Amphotericin B is utilized in septic patients with fungal or suspected fungal infections because of greater activity against

nonalbicans Candida compared to fluconazole. However, amphotericin B has a significantly higher rate of adverse reactions. Lipid formulations of amphotericin B (am-photericin B cholesteryl sulfate complex, lipid complex, and liposomal amphotericin B) are available that are less nephrotoxic and have decreased infusion-associated side effects. Efficacy among the amphotericin products is equivalent, but the lipid formulations are significantly more expensive. Lipid products are recommended for patients intolerant of conventional amphotericin. Other alternatives for treatment of fungal infections include voriconazole and echinocandins (anidulafungin, caspofungin, mi-cafungin). Data are lacking that demonstrate clinical superiority between agents.

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