Pharmacokinetic evaluation of fluconazole in critically ill patients

Sinnollareddy, Mahipal, Peake, Sandra L., Roberts, Michael S., Playford, E. Geoffrey, Lipman, Jeffrey and Roberts, Jason A. (2011) Pharmacokinetic evaluation of fluconazole in critically ill patients. Expert Opinion On Drug Metabolism and Toxicology, 7 11: 1431-1440. doi:10.1517/17425255.2011.615309

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Author Sinnollareddy, Mahipal
Peake, Sandra L.
Roberts, Michael S.
Playford, E. Geoffrey
Lipman, Jeffrey
Roberts, Jason A.
Title Pharmacokinetic evaluation of fluconazole in critically ill patients
Journal name Expert Opinion On Drug Metabolism and Toxicology   Check publisher's open access policy
ISSN 1742-5255
Publication date 2011-11
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1517/17425255.2011.615309
Volume 7
Issue 11
Start page 1431
End page 1440
Total pages 10
Place of publication London, United Kingdom
Publisher Informa Healthcare
Collection year 2012
Language eng
Formatted abstract
Introduction: Invasive candidiasis has emerged over the last few decades as an increasingly important nosocomial problem for the critically ill, affecting around 2% of intensive care unit patients. Although poor outcomes associated with invasive candidiasis among critically ill patients may relate to severe underlying disease processes and delayed institution of antifungal therapy, inadequate dosing of antifungal agents may also contribute.

Areas covered:
This drug evaluation provides a critical appraisal of the published literature pertaining to the pharmacokinetics of fluconazole in critically ill, obese or severely burned patients, including those receiving acute renal replacement therapy. The pharmacodynamics of fluconazole is also covered, as well as the likely clinical implications for optimal dosing and the toxicity of fluconazole. Last, variations in fluconazole susceptibility patterns of Candida spp. are also discussed.

Expert opinion:
Recently, there has been an increased but geographically variable prevalence of non-albicans Candida spp., causing invasive candidiasis and an overall trend towards reduced fluconazole susceptibility. The pathophysiological changes of critical illness, coupled with a lack of dose finding studies, support the use of local susceptibility patterns to guide fluconazole dosing until such time as pharmacokinetic–pharmacodynamic information to guide optimal fluconazole dosing strategies and pharmacodynamic targets becomes available.
Keyword Critically ill
Renal replacement therapy
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: UQ Centre for Clinical Research Publications
Official 2012 Collection
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 7 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 6 times in Scopus Article | Citations
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Created: Sun, 13 Nov 2011, 06:12:18 EST by System User on behalf of Anaesthesiology and Critical Care - RBWH