RESUMO
Currently, three echinocandins are available for the treatment of fungal infections. Micafungin is the latest drug to be incorporated into this group of antifungal agents. Although the mechanism of action of micafungin is similar to that of other echinocandins, this molecule has certain pharmacokinetic characteristics that distinguish it from other drugs in this group. Nowadays, there is wide information on the pharmacokinetic behavior of micafungin, mainly from patients included in clinical trials. However, there is far less knowledge of the pharmacokinetics of this echinocandin in special populations. The aim of the current review was to analyze the available information on the pharmacokinetics of micafungin in pediatric patients, the elderly, patients with renal insufficiency or liver failure, and transplant recipient.
Assuntos
Antifúngicos/farmacocinética , Equinocandinas/farmacocinética , Lipopeptídeos/farmacocinética , Micoses/tratamento farmacológico , Adolescente , Adulto , Fatores Etários , Idoso , Antifúngicos/administração & dosagem , Antifúngicos/uso terapêutico , Criança , Pré-Escolar , Ensaios Clínicos como Assunto , Comorbidade , Citocromo P-450 CYP3A/metabolismo , Interações Medicamentosas , Equinocandinas/administração & dosagem , Equinocandinas/efeitos adversos , Equinocandinas/uso terapêutico , Humanos , Lactente , Nefropatias/complicações , Nefropatias/metabolismo , Lipopeptídeos/administração & dosagem , Lipopeptídeos/efeitos adversos , Lipopeptídeos/uso terapêutico , Hepatopatias/complicações , Hepatopatias/metabolismo , Micafungina , Pessoa de Meia-Idade , Micoses/complicações , Micoses/metabolismo , Complicações Pós-Operatórias/tratamento farmacológico , Transplante , Adulto JovemRESUMO
BACKGROUND: Invasive candidiasis episodes have increased during last years and they have been related with high rates of crude mortality. Invasive candidiasis-related deaths have not diminished significantly with the introduction of antifungals in the past decade. Finantial managers are worried about extra costs from acquisition of new antifungal agents. AIM: This review includes the main studies age-stratified to assess different variables related to the economic burden of invasive candidiasis. METHODS: Systematic review of biomedic databases including Medline, PubMed and EMBASE. RESULTS: The studies show hospital stay as the main variable related with higher impact in the increase of invasive candidiasis costs. Acquisition costs of antifungals have a very low impact in the invasive candidiasis costs. CONCLUSIONS: Pharmacoeconomics applied in candidiasis invasive therapy must avoid assessing acquisition costs of antifungals exclusively, needing to include both direct and indirect costs associated with this fungal infection. The cost of antifungal acquisition represents a low impact in the overall economic burden of this fungal infection. Further pharmacoeconomics evaluations should be performed including similar definitions to decrease the possible bias in results interpretation.