Pharmacological management of antifungal agents in pulmonary aspergillosis: an updated review. Issue 2 (1st February 2022)

• Record Type: Journal Article
• Authors: Echeverria-Esnal, Daniel; Martín-Ontiyuelo, Clara; Navarrete-Rouco, Maria Eugenia; Barcelo-Vidal, Jaime; Conde-Estévez, David; Carballo, Nuria; De-Antonio Cuscó, Marta; Ferrández, Olivia; Horcajada, Juan Pablo; Grau, Santiago
• Is Part Of: Expert review of anti-infective therapy. Volume 20:Issue 2(2022)
• Page Start: 179
• Page End: 197
• Publication Date: 2022-02-01
• Subjects: Allergic bronchopulmonary aspergillosis -- antifungals -- Aspergillus -- chronic pulmonary aspergillosis -- invasive aspergillosis -- isavuconazole -- liposomal amphotericin B -- pharmacology -- posaconazole -- voriconazole; Anti-infective agents -- Research -- Periodicals; 616.90461
• DOI: 10.1080/14787210.2021.1962292
• Languages: English
• ISSNs: 1478-7210

Abstract

ABSTRACT: Introduction: Aspergillus may cause different types of lung infections: invasive, chronic pulmonary or allergic bronchopulmonary aspergillosis. Pharmacological management with antifungals poses as a challenge. Patients diagnosed with pulmonary aspergillosis are complex, as well as the problems associated with antifungal agents. Areas covered: This article reviews the pharmacology of antifungal agents in development and currently used to treat pulmonary aspergillosis, including the mechanisms of action, pharmacokinetics, pharmacodynamics, dosing, therapeutic drug monitoring and safety. Recommendations to manage situations that arise in daily clinical practice are provided. A literature search of PubMed was conducted on November 15 th, 2020 and updated on March 30 th, 2021. Expert opinion: Recent and relevant developments in the treatment of pulmonary aspergillosis have taken place. Novel antifungals with new mechanisms of action that extend antifungal spectrum and improve pharmacokinetic-related aspects, drug-drug interactions and safety are under current study. For those antifungals already marketed, new data related to pharmacokinetics, pharmacodynamics, dose adjustments in special situations, therapeutic drug monitoring and safety are available. To maximize efficacy and reduce the risk of associated toxicities, it is essential to choose the most appropriate antifungal; optimize its dose, interval, route of administration and length of treatment; and prevent side effects.