Related Experiment Video

Updated: Oct 7, 2026

An Ex vivo Assay to Study Candida albicans Hyphal Morphogenesis in the Gastrointestinal Tract
07:42

An Ex vivo Assay to Study Candida albicans Hyphal Morphogenesis in the Gastrointestinal Tract

Published on: July 1, 2020

Treatment of systemic fungal infections in older patients: achieving optimal outcomes

C A Kauffman1, S A Hedderwick

  • 1Infectious Diseases Section, Veterans Affairs Ann Arbor Healthcare System, University of Michigan Medical School, 48105, USA. ckauff@umich.edu

Drugs & Aging
|June 8, 2001
PubMed

Insights

Systemic fungal infections are rising in older adults due to travel and medical factors. Treatment requires careful consideration of drug interactions and toxicities, especially with azoles and amphotericin B.

Area of Science:

  • Mycology
  • Geriatrics
  • Infectious Diseases

Background:

  • Systemic fungal infections pose a growing threat to the aging population.
  • Increased international travel and use of immunosuppressive therapies contribute to this rise.
  • Opportunistic fungal infections are linked to intensive care unit stays and invasive devices.

Purpose of the Study:

  • To review the challenges and considerations for treating systemic fungal infections in older adults.
  • To evaluate the safety and efficacy profiles of common antifungal agents in this demographic.

Main Methods:

  • Literature review of endemic and opportunistic mycoses in older adults.
  • Analysis of treatment guidelines and drug-specific toxicities for azoles and amphotericin B.
  • Examination of pharmacokinetic and pharmacodynamic issues relevant to geriatric patients.

Main Results:

  • Older adults face increased risks from endemic and opportunistic fungal infections.
  • Azole antifungals present risks of drug-drug interactions and absorption issues in the elderly.
  • Amphotericin B carries nephrotoxicity and infusion-related risks, particularly in those with renal impairment.

Conclusions:

  • Antifungal treatment selection in older adults necessitates a thorough assessment of patient-specific factors, including comorbidities and concurrent medications.
  • While newer lipid formulations of amphotericin B may mitigate some toxicities, their specific role in older adults requires further clarification.
  • Managing systemic fungal infections in older adults demands a personalized approach to optimize therapeutic outcomes and minimize adverse events.

Related Concept Videos

Cryptococcal Meningitis01:27

Cryptococcal Meningitis

Cryptococcal meningitis is a life-threatening opportunistic infection predominantly associated with HIV/AIDS, accounting for over 100,000 deaths annually worldwide. However, it also affects individuals with other forms of immunosuppression, including those undergoing immunosuppressive therapy, organ transplant recipients, patients with innate immunodeficiencies, and individuals with hematological disorders. The infection is caused mainly by Cryptococcus neoformans and Cryptococcus gattii,...
Antifungal Agents01:15

Antifungal Agents

Amphotericin B is a broad-spectrum antifungal agent that exploits structural differences between fungal and mammalian cell membranes. Its amphipathic structure—featuring a hydrophobic polyene-lactone ring and a hydrophilic region containing mycosamine and carboxylic acid groups—enables selective binding to ergosterol, a sterol predominantly found in fungal plasma membranes. This selective interaction underlies the drug’s antifungal activity, although weak binding to cholesterol contributes to...
Drug Dosing: Geriatric Patients01:15

Drug Dosing: Geriatric Patients

Elderly individuals encompass a diverse population with varying degrees of age-related physiological changes. Defining the elderly presents challenges, as the geriatric population is often arbitrarily categorized as individuals older than 65. However, many individuals in this group lead active and healthy lives, with an increasing number surpassing 85 years and falling into the older elderly category. Physiological changes associated with aging impact performance capacity and homeostatic...
Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion01:18

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion

In geriatric patients, renal physiology undergoes significant changes, including diminished renal blood flow and a lower glomerular filtration rate (GFR), leading to alterations in medication clearance. Drugs such as aminoglycoside antibiotics, lithium, and digoxin, which rely on glomerular filtration for removal from the body, particularly impact pharmacokinetics. These drugs tend to have slower clearance rates in older adults, necessitating careful dosage considerations.Evaluation of renal...
Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Metabolism01:18

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Metabolism

Geriatric patients show significant variation in how their bodies process medications, which can change how effective and safe treatments are. The liver is the primary organ where drug metabolism occurs, involving two main types of chemical reactions: phase I and II. Phase I metabolism is driven by the cytochrome P450 enzyme system, which includes key types such as CYP3A, CYP2D6, and CYP2C9. Research indicates that while aging doesn't notably alter the levels or activity of these enzymes, it...
Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Absorption01:22

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Absorption

As individuals age, their body's physiology evolves, affecting drug pharmacokinetics. The most apparent changes occur in the gastrointestinal tract, where an increase in gastric pH, a delay in gastric emptying, and a reduction in gastrointestinal motility are observed. Remarkably, these changes do not substantially modify the absorption of orally administered drugs, particularly those absorbed via passive diffusion.Transdermal drug delivery emerges as a highly viable method for older adults due...