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Review
. 2018 Sep;35(9):781-789.
doi: 10.1007/s40266-018-0576-9.

Invasive Candidiasis in the Elderly: Considerations for Drug Therapy

B G J Dekkers  1 , A Veringa  1 , D J E Marriott  2 , J M Boonstra  1 , K C M van der Elst  3 , F F Doukas  4   5   6 , A J McLachlan  4 , Jan-Willem C Alffenaar  7
Affiliations
Review

Invasive Candidiasis in the Elderly: Considerations for Drug Therapy

B G J Dekkers et al. Drugs Aging. 2018 Sep.

Abstract

Candida infections in the elderly are an important and expanding clinical problem, with significantly higher mortality in this group than in younger patients. The increasing problem of invasive Candida infections may be related to higher prevalence of immunocompromised older people and the emergence of treatment resistance. Older people, especially the frail and critically ill, are at higher risk of medication-related harmful effects due to changes in pharmacokinetics and pharmacodynamics, which may be further complicated by organ dysfunction, diminished homeostatic control, co-morbidities and polypharmacy. Here, we review the available options for the treatment of Candida infections and provide insights into the challenges surrounding the optimal use of antifungal drugs in the elderly.

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Conflict of interest statement

B.G.J. Dekkers, A. Veringa, D.J.E. Marriott, J.M. Boonstra, K.C.M. van der Elst, F.F. Doukas, A.J. McLachlan and J.W.C. Alffenaar declare no conflicts of interest relevant to this paper.

Figures

Fig. 1
Fig. 1
Pharmacodynamic and pharmacokinetic considerations in older people. RCT randomised controlled trial
Fig. 2
Fig. 2
Criteria a drug should fulfil to perform therapeutic drug monitoring (TDM). TDM can be performed during the treatment of an invasive fungal infection or in the prophylaxis setting. For several antifungal agents TDM is recommended during treatment (see text). TDM should be repeated regularly during treatment. TDM can be considered in a prophylaxis setting
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References

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