Guest guest Posted November 7, 2009 Report Share Posted November 7, 2009 Hi Pete,   If Diflucan (fluconazole) is NOT working, this current journal article advises using one of the Echinocandins, which, according to this article, have " fungicidal activity against most Candida spp., including strains that are fluconazole-resistant. " Fluconazole is the generic name for Diflucan.  Show this journal article to a doctor, to get him to prescribe one of these medicines. If you just tell him that " you read about it somewhere " it won't carry as much clout, as showing him the actual article. Sorry that all I can show you is the Abstract. My " Magic Library Card " couldn't get me the full-text of this article.  It's nice to see you posting again.  Good luck, and God Bless, Joe ................................................................  Published Online, 1 September 2009, www.theannals.com, DOI 10.1345/aph.1M237. The ls of Pharmacotherapy: Vol. 43, No. 10, pp. 1647-1657. DOI 10.1345/aph.1M237 © 2009 Harvey Whitney Books Company.  INFECTIOUS DISEASES  Echinocandins: The Newest Class of Antifungals  Allana J Sucher, PharmD BCPS  Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 8, 2009 Report Share Posted November 8, 2009 If Diflucan (fluconazole) is NOT working, this current journal article, that I have cut and pasted below, advises using one of the Echinocandins, which, according to this article, have " fungicidal activity against most Candida spp., including strains that are fluconazole-resistant. " Fluconazole is the generic name for Diflucan.  Show this journal article to a doctor, to get him to prescribe one of these medicines. If you just tell him that " you read about it somewhere " it won't carry as much clout, as showing him the actual article. Sorry that all I can show you is the Abstract. My " Magic Library Card " couldn't get me the full-text of this article.  It's nice to see you posting again, Pete.  Good luck, and God Bless, Joe This is article I got from library on " the newest class of antifungals " : Published Online, 1 September 2009, www.theannals.com, DOI 10.1345/aph.1M237. The ls of Pharmacotherapy: Vol. 43, No. 10, pp. 1647-1657. DOI 10.1345/aph.1M237 © 2009 Harvey Whitney Books Company.  INFECTIOUS DISEASES  Echinocandins: The Newest Class of Antifungals  Allana J Sucher, PharmD BCPS  at time of writing, Associate Professor of Pharmacy Practice, Lloyd L. School of Pharmacy, Palm Beach Atlantic University, West Palm Beach, FL; now, Associate Professor of Pharmacy Practice, Regis University School of Pharmacy, Denver, CO  Elias B Chahine, PharmD BCPS  Assistant Professor of Pharmacy Practice, Lloyd L. School of Pharmacy, Palm Beach Atlantic University  Holly E Balcer, PharmD BCPS  Clinical Pharmacy Specialist, Roper St. Francis Healthcare System, ton, SC   OBJECTIVE: To review the mechanism of action, antifungal spectrum of activity, pharmacodynamics, pharmacokinetics, clinical efficacy, and safety of the echinocandins.  DATA SOURCES: A MEDLINE search (1982–May 2009) was conducted for articles published in the English language using the key words caspofungin, micafungin, anidulafungin, and echinocandins.  STUDY SELECTION AND DATA EXTRACTION: Medicinal chemistry, in vitro, and animal studies, as well as human trials were reviewed for information on the pharmacodynamics, pharmacokinetics, efficacy, and safety of each echinocandin. Clinical trials were reviewed and included to compare and contrast the available echinocandins.  DATA SYNTHESIS: Three echinocandin antifungal agents are currently approved for use in the US: caspofungin, micafungin, and anidulafungin. The echinocandins have a unique mechanism of action, inhibiting β-(1,3)-D-glucan synthase, an enzyme that is necessary for the synthesis of an essential component of the cell wall of several fungi. The echinocandins display fungistatic activity against Aspergillus spp. and fungicidal activity against most Candida spp., including strains that are fluconazole-resistant. The echinocandins have been shown to be efficacious for the treatment of esophageal candidiasis, candidemia, and invasive candidiasis. In addition, caspofungin has demonstrated efficacy as empiric treatment of febrile neutropenia and salvage therapy for the treatment of invasive aspergillosis, and it is the only echinocandin approved for use in pediatric patients. Micafungin is the only echinocandin approved for use as prophylaxis against Candida infections in patients undergoing hematopoietic stem cell transplantation. Overall, resistance to echinocandins is still rare, and all agents are well tolerated, with similar adverse effect profiles and few drug–drug interactions.  CONCLUSIONS: Echinocandins, the newest addition to the arsenal of antifungals, offer potential advantages over other classes of agents. Clinicians should assess their distinguishing characteristics, including route of metabolism, drug interaction profile, and approved indications for use, when determining which agent to include on a formulary.   Key Words: anidulafungin, antifungal, caspofungin, echinocandins, fungal infections, micafungin  Published Online, September 1, 2009. www.theannals.com, DOI 10.1345/aph.1M237  Quote Link to comment Share on other sites More sharing options...
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