Antifungals have come a LOOOONGGG way but we still lose many battles against these stubborn bugs
Let's focus on ๐๐จ๐ซ๐ข๐๐จ๐ง๐๐ณ๐จ๐ฅ๐ today !!
A short thread.
#antifungals #IDTwitter #oncology #MedTwitter #MedStudentTwitter #hematology
Let's focus on ๐๐จ๐ซ๐ข๐๐จ๐ง๐๐ณ๐จ๐ฅ๐ today !!
A short thread.
#antifungals #IDTwitter #oncology #MedTwitter #MedStudentTwitter #hematology
For years AmpB was the go to agent for invasive #fungal infections. Plagued by infusion reactions & nephrotoxicity we desperately needed newer agents
๐๐ณ๐จ๐ฅ๐๐ฌ ๐ฐ๐๐ซ๐ ๐ญ๐ก๐ ๐๐ง๐ฌ๐ฐ๐๐ซ.
๐๐ฆ๐ข๐๐๐ณ๐จ๐ฅ๐๐ฌ like ketoconazole were the 1st on the scene. FDA approved :1981
๐๐ณ๐จ๐ฅ๐๐ฌ ๐ฐ๐๐ซ๐ ๐ญ๐ก๐ ๐๐ง๐ฌ๐ฐ๐๐ซ.
๐๐ฆ๐ข๐๐๐ณ๐จ๐ฅ๐๐ฌ like ketoconazole were the 1st on the scene. FDA approved :1981
๐๐ซ๐ข๐๐ณ๐จ๐ฅ๐๐ฌ were next in line. The 1st generation flucon and itraconazole and the 2nd generation ๐๐จ๐ซ๐ข๐๐จ๐ง๐๐ณ๐จ๐ฅ๐
The FDA approved it in May 2002 for the Rx on invasive aspergillosis
It acts by 14 ฮฑ lanosterol demethylase which l/tErgosterol synthesis
The FDA approved it in May 2002 for the Rx on invasive aspergillosis
It acts by 14 ฮฑ lanosterol demethylase which l/tErgosterol synthesis
It reaches max plasma concentration 1-2hrs after an oral dose
Extensively hepatically metabolized to N-Oxide metabolite by the CYP 450 system
In poor metabolizers the AUC is 4x
Extensively hepatically metabolized to N-Oxide metabolite by the CYP 450 system
In poor metabolizers the AUC is 4x
๐๐จ๐ซ๐ข๐๐จ๐ง๐๐ณ๐จ๐ฅ๐ ๐๐จ๐ฌ๐ข๐ง๐ :
๐๐ฆ๐ /๐ค๐ q12h for 2 doses๐๐ฆ๐ /๐ค๐ q12h thereafter.
Adults <40kg :maintenance dose by 50%
CTP A & B CLD:maintenance dose by 50%
CTP C CLD: No data
๐๐ฏ๐จ๐ข๐ ๐ฆ๐๐๐ฅ๐ฌ ๐๐ก๐ซ ๐๐๐๐จ๐ซ๐ ๐๐ง๐ ๐๐๐ญ๐๐ซ ๐จ๐ซ๐๐ฅ ๐๐จ๐ฌ๐
๐๐ฆ๐ /๐ค๐ q12h for 2 doses๐๐ฆ๐ /๐ค๐ q12h thereafter.
Adults <40kg :maintenance dose by 50%
CTP A & B CLD:maintenance dose by 50%
CTP C CLD: No data
๐๐ฏ๐จ๐ข๐ ๐ฆ๐๐๐ฅ๐ฌ ๐๐ก๐ซ ๐๐๐๐จ๐ซ๐ ๐๐ง๐ ๐๐๐ญ๐๐ซ ๐จ๐ซ๐๐ฅ ๐๐จ๐ฌ๐
๐๐๐ฏ๐๐ซ๐ฌ๐ ๐๐๐๐๐ญ๐ข๐จ๐ง๐ฌ:
Visual Disturbances(~30%) Blurred vision, photophobia etc. Occurs within 1/2hr of dosing & lasts for abt 1/2hr MC during 1st week of therapy. Reversible
Transaminitis(15%) including cases of ALF.
Skin Reactions(5%) rarely need Rx discont
Visual Disturbances(~30%) Blurred vision, photophobia etc. Occurs within 1/2hr of dosing & lasts for abt 1/2hr MC during 1st week of therapy. Reversible
Transaminitis(15%) including cases of ALF.
Skin Reactions(5%) rarely need Rx discont
๐๐ซ๐๐ฅ Voriconazole can be safely given to all CKD patients.
๐๐ to be avoided at CrCl<50ml/min d/t accumulation of SBECD vehicle.
Voriconazole is a ๐๐๐๐๐๐ ๐ข๐ง๐ก๐ข๐๐ข๐ญ๐จ๐ซ & drug interactions must always be kept in mind when prescribing.
๐๐ to be avoided at CrCl<50ml/min d/t accumulation of SBECD vehicle.
Voriconazole is a ๐๐๐๐๐๐ ๐ข๐ง๐ก๐ข๐๐ข๐ญ๐จ๐ซ & drug interactions must always be kept in mind when prescribing.
๐๐จ๐ซ๐ข๐๐จ๐ง๐๐ณ๐จ๐ฅ๐ ๐ซ๐๐ฌ๐ข๐ฌ๐ญ๐๐ง๐๐ is an emerging problem. It ranges from 10-35% in various reports.
The figure below highlights the MC mech of resistance acquisition. Mutations in the ๐๐๐๐๐๐ ๐ ๐๐ง๐ are an important cause.
The figure below highlights the MC mech of resistance acquisition. Mutations in the ๐๐๐๐๐๐ ๐ ๐๐ง๐ are an important cause.
This thread is a recapitulation of the basics. Important for beginners like myself, might not interest the seniors in the field.
References:
doi:10.1111/j.1470-9465.2004.00841.x
doi:10.1080/08998280.2003.11927910
http://doi.org/10.1007/s00210-020-01950-x
References:
doi:10.1111/j.1470-9465.2004.00841.x
doi:10.1080/08998280.2003.11927910
http://doi.org/10.1007/s00210-020-01950-x
@sujeethemat @MedTweetorials @SChellapuram @ID_fellows @IJMPOofficial @med_to_bed @DrESHAJ9 @Gurleenoberoi18 @docsamdeshmukh @DigambarPanchal @SujayRainchwar @NutanJoshi27 plz add more to this thread.