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Antimykotika: aktuelle og nye

Antimykotika: aktuelle og nye. Candida. Maiken Arendrup. Mykologisk afsnit. mad@ssi.dk SSI. C. albicans. Non-alb. Antimykotika. Cellevæg ß-1,3 glucan. -. Caspofungin. Lanosterol. Ergosterol. Cyt P450. -. Amfotericin B. -. -. -. Azoler: 1’ og 2’ Flu- itra- og ketoconazol

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Antimykotika: aktuelle og nye

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  1. Antimykotika: aktuelle og nye Candida Maiken Arendrup. Mykologisk afsnit. mad@ssi.dk SSI. C. albicans Non-alb

  2. Antimykotika Cellevæg ß-1,3 glucan - Caspofungin Lanosterol Ergosterol Cyt P450 - Amfotericin B - - - • Azoler: 1’ og 2’ • Flu- itra- og ketoconazol • Voriconazol 5-FC Allylaminer

  3. Antimykotika spektrum: Gærsvampe

  4. Antimykotika spektrum: andre

  5. Farmakokinetik: voksne

  6. Famakodynamik Andes, AAC, 2003

  7. Candida susceptibility i Biofilm Ramage, AAC. 2002; Lewis, AAC 2002.

  8. Candidæmi, CVK’s betydning • 189 episoder af candidæmi, 123 med CVK. Mortalitet: • Fortsat CVK (65% vs. 23%) Luzzati R. Eur J Clin Microbiol Infect Dis 2000 • 164 episoder af candidæmi. Mortalitet: • CVK > 2 uger (OR 3,55) Gottfredsson. SSAC møde 2000 . • 104 episoder af candidæmi blandt neonatale. Karlowicz. Pediatrics. 2000

  9. Proteinsyntese elongationsfaktor 2 Iso-leucyl-tRNA synthetase Cyt P450 hsp90 Nye Antimykotika • Candiner • Micafungin og Anidulafungin • HMR 3270 • Sordariner • Glaxo - • ß-amino acids • PLD-118 • Polyener • Nyotran(nystatin) - • Efflux Pump Inhibitor • Milbemycin - - - • Chitinsyntase hæm. • Nikkomycin Z • Nye Azoler • Posaconazole og Ravuconazole • T-8581, D0870, UR-9746/ 9751, KP-103 - Mycograb

  10. Antimykotika spektrum: future drugs

  11. Konklusion • Antimykotika  • 4 klasser til systemiske infektioner • 5 nye klasser på vej • Store forskelle • Spektrum • Toxicitet • PK og PD forhold • Proteinbinding • Pris • Biofilm associeret Candida øget resistens

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