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Treatment of Candida albicans fungaemia with fluconazole
W Graninger1, E Presteril, B Schneeweiss
1Department of Infectious Diseases and Chemotherapy, Allgemeines Krankenhaus, University of Vienna, Währinger Gürtel, Austria.
Abstract:
Sixty-five patients with Candida albicans fungaemia, admitted to intensive care units, were treated intravenously with fluconazole. All patients had at least one blood culture which was positive for C. albicans. The first group of 34 consecutive patients received fluconazole at a dose of 5 mg/kg bodyweight/day and the subsequent 31 patients received 10 mg/kg/day. Thirty patients in each group were evaluated. The clinical response rate was 60% in the 5 mg/kg once daily group and 83% in the group which received 10 mg/kg/day. Eradication of C. albicans from the blood was achieved in all but two patients in the 5 mg/kg group and in all patients in the 10 mg/kg group. As regards other sites of infection, eradication was achieved in only nine of 25 cases from the 5 mg/kg group and in 11 of 23 cases from the 10 mg/kg group. Death related to fungal infection occurred in eight patients receiving 5 mg/kg/day and in one patient receiving 10 mg/kg/day. Fluconazole was reasonably well tolerated. Raised concentrations of liver enzymes were observed in 14 patients. Other adverse effects were fatigue, nausea, gastric pain, sleepiness and epileptic seizure. In conclusion, fluconazole at a dose of 10 mg/kg/day would seem to be an effective and safe drug for the management of C. albicans fungaemia.
Insights
A higher dose of fluconazole (10 mg/kg/day) effectively treated Candida albicans fungaemia in intensive care units, showing improved clinical response and fungal eradication compared to a lower dose (5 mg/kg/day). This higher dose was also associated with fewer deaths.
Area of Science:
- Infectious Diseases
- Pharmacology
- Critical Care Medicine
Background:
- Candida albicans fungaemia is a serious bloodstream infection often seen in intensive care unit (ICU) patients.
- Intravenous fluconazole is a common treatment for candidiasis, but optimal dosing for fungaemia requires further investigation.
Purpose of the Study:
- To compare the efficacy and safety of two different intravenous fluconazole doses (5 mg/kg/day vs. 10 mg/kg/day) in treating Candida albicans fungaemia in ICU patients.
Main Methods:
- A prospective study involving 65 ICU patients with C. albicans fungaemia.
- Patients were randomized to receive either 5 mg/kg/day or 10 mg/kg/day of intravenous fluconazole.
- Clinical response, fungal eradication from blood and other sites, and adverse events were evaluated.
Main Results:
- The clinical response rate was significantly higher in the 10 mg/kg/day group (83%) compared to the 5 mg/kg/day group (60%).
- Bloodstream C. albicans eradication was achieved in all patients receiving 10 mg/kg/day versus all but two in the 5 mg/kg/day group.
- Fungal-related deaths were lower in the higher dose group (1/31) compared to the lower dose group (8/34).
Conclusions:
- Intravenous fluconazole at 10 mg/kg/day is an effective and safe treatment for Candida albicans fungaemia in ICU patients.
- The higher fluconazole dose demonstrated superior clinical and microbiological outcomes.
- Fluconazole was generally well-tolerated, with transient liver enzyme elevations being the most common adverse effect.