2008 IDSA Candidiasis Guidelines.ppt

Rex summary of updated IDSA Candidiasis guidelines.ppt Rex summary of updated IDSA Candidiasis guidelines.ppt 2008 IDSA Candidiasis Guidelines John H. Rex, MD Adjunct Professor of Medicine; University of Texas Medical School-Houston Vice President Clinical Infection, AstraZeneca Pharmaceuticals How were they created? Current version is from 2004 Clin Infect Dis 2004;38:161-189 A group of 14 international authorities began work a revision in spring 2007. There are 15 major topics addressed in the revised version Each recommendation is given a ‘grade’ based on the strength of evidence (eg, A-I, B-II, C-III) An evidence summary follows each recommendation Key organism principles Helpful to know tiers of progressive difference (most virulent, most susceptible): albicans, parapsilosis, tropicalis, dubliniensis (intermediate): glabrata (least virulent, least susceptible: krusei You often know quickly if C. albicans It’s the one that is “germ tube-positive” Just knowing species is very helpful P = Plastic = parapsilosis. Look for the device! Resistance patterns glabrata krusei: Azoles are dicey. Newer azoles are better parapsilosis: Echinocandins sometimes a little weaker lusitaniae: Amphotericin resistance is frequent guilliermondii: higher azole and candin MICs Hint about your patient Glabrata and krusei are weaklings. When seen, says much about patient Key drug principles Voriconazole Fatty meal reduces absorption IV form uses cyclodextrin: not well cleared by dialysis Lots of drug-drug interaction Candins Very few convincing differences Usually cross-resistant – but not always! (emerging data) Amphotericins Always use trade name for lipid-associated forms Do not utter phrase “liposomal amphotericin B”: error very easy Liposomal amphotericin B = AmBisome Amphotericin B lipid complex = ABLC = Abelcet Amphotericin B colloidal dispersion = ABCD = Amphotec (Classic ampho = Amphotercin B deoxycholate = Fungizone) Major guideline changes from 2004 Emphasis on fluconazole an