Patient monitoring and side effects

Response to antifungal therapy in invasive candidiasis is often more rapid than for endemic fungal infections. Resolution of fever and sterilization of blood cultures are indications of response to antifungal therapy. Toxicity associated with antifungal therapy is similar in these patients as described earlier with the caveat that some toxicities may be more pronounced in critically-ill patients with invasive candidiasis. Nephrotoxicity and electrolyte disturbances, with amphotericin B in particular, are problematic and may not be avoidable even with lipid amphotericin B formulations. Therefore, there is a growing emphasis on the first-line use of fluconazole in lower-risk patients and echinocandins in higher-risk patients to reduce the potential for patient adverse effects. Decisions to use one class of antifungal agents over the other are principally driven by concerns of nonalbicans species, patient tolerability, or history of prior fluconazole exposure (risk factor for nonalbicans species.).

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