【貓】評論

目前對Candida krusei克魯斯念珠菌有抗藥性的anti-fungi agents: Fluconazole, ItrconazoleUpToDate- Management of candidemia and invasive candidiasis in adults-Targeted and step-down therapy段落:C. krusei — For targeted treatment of candidemia due to C. krusei, an echinocandin is the preferred antifungal agent. In general, most C. krusei isolates are resistant to fluconazole but remain susceptible to the echinocandins ; however, rare cases of echinocandin resistance have been reported . C. krusei isolates can also demonstrate decreased susceptibility to amphotericin B; for this reason, higher doses of amphotericin B are warranted for the treatment of C. krusei infections (5 mg/kg daily of lipid-based formulations).For oral step-down therapy of C. krusei infection, voriconazole is recommended; C. krusei is intrinsically resistant to fluconazole due to an altered cytochrome P450 isoenzyme.總結重點:1.對於C. krusei引起的candidemia，echinocandin(-fungin)和amphotericin B是首選藥物，但有部分菌株對amphotericin B 敏感性下降趨勢，建議使用較高劑量amphotericin B(5 mg/kg daily of lipid-based formulations)2.普遍C. krusei對fluconazole有抗藥性，其抗藥性原因在於cytochrome P450的變異性3.C. krusei的口服降階抗黴菌藥首選為Voriconazole(Vfend* 200mg/tab) #1 bid====補充:1.amphotericin B:抗黴菌圖譜廣，只有少數種類無法使用(Aspergillus terreus土麴菌、Candida lusitaniae葡萄牙念珠菌、scedo spp.賽多孢子菌)，使用歷史久，算是anti-fungi agents中的元老2.Fluconazole(Fluene* 50mg/cap):大原則是口服降階藥的首選考量，但抗黴菌圖譜有限(抗藥性多，eg. Aspergillus, C. auris耳念珠菌, C.krusei, etc)，且須腎功能調整常用用法量為400mg q24h(or 6mg/kg q24h)  ≒ #8 cap q24h用在candida spp(C. auris,  C.krusei除外)和crytptococcus隱球菌

【加賴叫過去】評論

節錄自Uptodate：C. krusei — For targeted treatment of candidemia due to C. krusei, an echinocandin is the preferred antifungal agent. In general, most C. krusei isolates are resistant to fluconazole but remain susceptible to the echinocandins; however, rare cases of echinocandin resistance have been reported. C. krusei isolates can also demonstrate decreased susceptibility to amphotericin B; for this reason, higher doses of amphotericin B are warranted for the treatment of C. krusei infections (5 mg/kg daily of lipid-based formulations).For oral step-down therapy of C. krusei infection, voriconazole is recommended; C. krusei is intrinsically resistant to fluconazole due to an altered cytochrome P450 isoenzyme; this resistance cannot be overcome with use of higher drug doses.簡單說就是C. krusei 這種黴菌對fluconazole有抗藥性，所以直接選fluconazole就好了。

【Fexofenadine】評論

[UpToDate: Management of candidemia and invasive candidiasis in adults]對於治療Candida krusei所引起的菌血症，使用Echinocandin是首選治療，大多對Fluconazole會有抗藥性。Candida krusei — For targeted treatment of candidemia due to C. krusei, an echinocandin is the preferred antifungal agent. In general, most C. krusei isolates are resistant to fluconazole but remain susceptible to the echinocandins [61]; however, rare cases of echinocandin resistance have been reported [62-64]. C. krusei isolates can also demonstrate decreased susceptibility to amphotericin B; for this reason, higher doses of amphotericin B are warranted for the treatment of C. krusei infections (5 mg/kg daily of lipid-based formulations).For oral step-down therapy of C. krusei infection, voriconazole is recommended; C. krusei is intrinsically resistant to fluconazole due to an altered cytochrome P450 isoenzyme; this resistance cannot be overcome with use of higher drug doses [65]. Voriconazole binds more effectively to the cytochrome P450 isoenzyme in C. krusei than fluconazole, resulting in higher susceptibility rates [66]. Cross-resistance between voriconazole and fluconazole does not occur with C. krusei, as has been described with C. glabrata.There are geographic differences in the incidence of voriconazole-resistant C. krusei. In an international surveillance study, which included 326 bloodstream isolates of C. krusei, voriconazole resistance was observed in only 7.4 percent of isolates; such resistance was most common among isolates from Latin America and uncommon among isolates from North America and Europe [61].REF: UpToDate, [臨床藥學] 不同Candida (念珠菌屬)感染的抗黴菌藥選擇

【Filgrastim zz】評論

幫大家摘要Candida 重點：ＤCandida albican: 最常見Candida krusei: fluconazole, itraconazole 無效Candida auris: 常具有多重抗藥性，傳統的檢驗方法難以鑑定，衛福部疾管署有專門針對Candida auris 感染管制建議Candida lusitaniae: 對於amphotericin B有先天抗藥性ref:[1] Nett, J. E., & Andes, D. R. (2016). Antifungal Agents: Spectrum of Activity, Pharmacology, and Clinical Indications. Infectious disease clinics of North America, 30(1), 51–83. [2] Candida auris感染管制建議- 衛生福利部疾病管制署