International journal of antimicrobial agents
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Int. J. Antimicrob. Agents · Oct 2013
ReviewCandidaemia in the non-neutropenic patient: a critique of the guidelines.
Several guidelines have been published on the management of candidaemia. These guidelines vary in their recommendations, and the lack of consistency between the guidelines has implications for the management of candidaemia. ⋯ We found that too much emphasis has been placed on themes such as predicting the infecting species (and therefore fluconazole susceptibility) or the need for investigations such as echocardiography. We also stress that guidelines fail to provide adequate information (due to lack of evidence) on the most relevant issues that clinicians face when managing candidaemia, such as the place for fluconazole in the treatment of C. glabrata, the clinical relevance of dose-dependent susceptibility to fluconazole, and the timing of step-down therapy.
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Int. J. Antimicrob. Agents · Oct 2013
ReviewWhat is the relevance of fosfomycin pharmacokinetics in the treatment of serious infections in critically ill patients? A systematic review.
As treatment options for critically ill patients with multidrug-resistant bacteria diminish, older antibiotics such as fosfomycin are being investigated for use as last-resort drugs. Fosfomycin is a broad-spectrum antibiotic with activity both against Gram-positive and Gram-negative bacteria. The aim of this review was to examine the effectiveness of current fosfomycin dosing strategies in critically ill patients. ⋯ If altered as seen in acute kidney injury, toxic blood concentrations may develop. Fosfomycin has a volume of distribution comparable with β-lactams and aminoglycosides and may therefore increase in critically ill patients. Altered dosing strategies may be required to optimise dosing given these PK changes, although the current paucity of data on fosfomycin in critically ill patients prevents accurate dosing guidance being recommended at this time.