Use of Antifungal Therapies in Patients with Sepsis

FungizoneWithin the last two years, new therapies have been introduced to treat invasive fungal infections: caspofungin acetate (Cancidas®, Merck) and voriconazole (Vfend®, Pfizer). Caspofungin is the first in a new class of drugs called echinocandins that work by inhibiting synthesis of the fungal cell wall. Voriconazole is a new triazole antifungal medication indicated for the primary treatment of acute invasive aspergillosis and as salvage therapy for rare but serious fungal infections caused by the pathogens Scedosporium apiospermum and Fusarium species.

According to data from MediMedia’s Hospital Diagnosis and Therapy Audit, the most common infection treated with these injectable agents was septicemia, a serious, rapidly progressive, life-threatening systemic disease that can arise from pathogenic organisms or their toxins throughout the body—including those in the lungs, abdomen, and urinary tract. The death rate is high, exceeding 50%, depending on the type of organism involved. From an analysis of the data from July through September 2002, the mortality rate for sepsis patients was 20% overall; however, there were variations, depending on treatment. cialis canadian pharmacy

We reviewed the discharge status and mortality rates for patients who received injectable voriconazole, ampho-tericin B (Fungizone®, Geneva), caspofungin, and flu-conazole (Diflucan®, Pfizer). These findings are summarized in Figure 1 and Table 1.

Table 1 Length of Hospitalization and Therapy in Patients with Septicemia

Injectable

Length of Stay

Length of Therapy

Antifungal Agent

(in Days)

(in Days)

Voriconazole

33

6

Amphotericin B

51

8

Fluconazole

33

8

Caspofungin

68

11

The average length of stay for an inpatient with a diagnosis of septicemia was 15.5 days; however, for patients who required treatment with an injectable antifungal agent, the hospital stay was much longer.

One advantage of voriconazole and fluconazole is their availability in an oral form, which allows for flexibility in patient care and step-down therapy. This is an important consideration in the treatment of patients with invasive fungal infections. Patients often require medication for an extended period of time as maintenance therapy after discharge.

Figure 1 Discharge status for patients with septicemia

Figure 1 Discharge status for patients with septicemia who were receiving selected therapies. Note that many more patients received treatment with fluconazole and amphotericin B than with the two newer therapies. Projected number of patients: amphotericin B (3,267), voriconazole (196), fluconazole (15,505), and caspofungin (416).

Caspofungin is available in intravenous form only. Ampho-tericin B can be administered intravenously, topically, and orally as a liquid; however, its side-effect profile is commonly known as “shake and bake.” The significant number of patients who experience fever and chills makes the therapy intolerable in many cases; however, the data showed it to be superior to the other medications in relation to survival rates and to the number of patients discharged home after hospitalization for septicemia.
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The data cited here are available free of charge to hospitals that participate in the PharmScope Insights program. MediMedia specializes in helping hospital pharmacies to target areas for performance improvement by providing benchmarks from a panel of more than 70 hospitals nationwide. For information about joining PharmScope Insights, a division of MediMedia USA

Category: Main

Tags: Antifungal Therapies, Patients

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