The number of pages within the document is: 33
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Jeniel E. Nett MD PhD
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2019-02-05 23:07:34.119802
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AntifungalAgents SpectrumofActivity,Pharmacology,and ClinicalIndications JenielE.Nett, MD,PhD a,b,DavidR.Andes, MDa,b,*INTRODUCTION:THEEVOLUTIONOFANTIFUNGALDRUGTHERAPY Continuedadvancementofmedicalscienceofferslife-savingtreatmentoptionsfora varietyofhematologic,oncologic,andrheumatologicconditions.Immunosuppres- sion,acommontherapeuticside-effect,predisposespatientstoinvasivefungal infections,whichareescalatinginprevalence. 1,2Thedevelopmentofeffective,well- toleratedantifungalshaslaggedbehindtheadvancesofantibacterialtherapy. AmphotericinBdeoxycholate,anantifungaldevelopedinthe1950s,markedamajor therapeuticadvance( Box1 ).Althoughveryeffectiveforthetreatmentofnumerous DisclosureStatement:Theauthorshavenothingtodisclose. aDepartmentofMedicine,UniversityofWisconsin,Madison,WI53705,USA; bDepartmentof MedicalMicrobiology&Immunology,UniversityofWisconsin,Madison,WI53705,USA *Correspondingauthor.5211UWMedicalFoundationCentennialBuilding,1685Highland Avenue,Madison,WI53705. E-mailaddress: dra@medicine.wisc.eduKEYWORDSAntifungalSpectrumofactivity AzoleEchinocandins AmphotericinB PharmacokineticsIndicationsToxicityKEYPOINTS Thecurrentlyavailableantifungalagentsvarysignificantlyintermsofspectrumofactivity. Theechinocandinsexhibitpotentactivityagainst Candida,whereasthenewertriazoles offeranextendedspectrumofactivitythatincludes Aspergillus andemergingfilamentous pathogens. Thepharmacokineticpropertiesdifferamongtheantifungaldrugs.Importantconsider- ationsincludeabsorption,tissuesitepenetration,impactoforgandysfunctionondosing, routesofmetabolism,andtheneedfortherapeuticdrugmonitoring. ManytriazolesaremetabolizedviahepaticCYP450enzymes.DrugŒdruginteractionsare frequentandcommonenzymepolymorphismsmayleadtounpredictabledruglevels. DrugdosingandFoodandDrugAdministrationŒapprovedclinicalindicationsforindivid- ualantifungaldrugsarereviewed. InfectDisClinNAm -(2015) -Œ-http://dx.doi.org/10.1016/j.idc.2015.10.012 id.theclinics.com0891-5520/15/$Œseefrontmatter 2015ElsevierInc.Allrightsreserved.
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