Background
- Antifungal in the triazole family with excellent bioavadilability but limited efficacy outside of Candida
Pharmacokinetics and Pharmacodynamics
- Good oral bioavailability
- Good CNS penetration
- Fungistatic
- Efficacy predicted by AUC/MIC ratio
Breakpoints
| Species | ECV (μg/mL) | Breakpoints (μg/mL) | Breakpoints (mm) | ||||||
|---|---|---|---|---|---|---|---|---|---|
| S | I | SDD | R | S | I | SDD | R | ||
| Candida albicans | 0.5 | ≤2 | — | 4 | ≥8 | ≥17 | — | 14-16 | ≤13 |
| Candida dubliniensis | 0.5 | ||||||||
| Candida glabrata | 8 | — | — | ≤32 | ≥64 | — | — | ≥15 | ≤14 |
| Candida guilliermondii | 8 | ||||||||
| Candida krusei | intrinsically resistant | intrinsically resistant | |||||||
| Candida lusitaniae | 1 | ||||||||
| Candida parapsilosis | 1 | ≤2 | — | 4 | ≥8 | ≥17 | — | 14-16 | ≤13 |
| Candida tropicalis | 1 | ≤2 | — | 4 | ≥8 | ≥17 | — | 14-16 | ≤13 |
| Cryptococcus neoformans | 8 | ||||||||
| Cryptococcus gattii | 16-32 | ||||||||
Monitoring
- ECG for QT prolongation
- Liver enzymes for hepatitis
Adverse Drug Reactions
- Best side effect profiles of the antifungals
- Before starting, check:
- Liver enzymes as baseline (hepatitis)
- Creatinine (requires renal dosing)
- EKG (QTc prolongation)
- Beware drug-drug interactions, especially with new DOACs
