Abstract
In this study, we examined the toxicities, including poisoning and overdoses, with polyene, azole, flucytosine and echinocandin antifungals reported to the Swiss National Poison Centre. An observational cross-sectional study on antifungals was performed based on reports between 1995 and 2016 to Tox Info Suisse. Patient demographic and clinical characteristics were summarised among all reported calls, stratified by age group. In secondary analyses, we evaluated cases with clinical follow-up information. In total, 149 cases were reported to the National Poison Centre during the study period, of which 49 (32.9%) were male and 91 (61.1%) were female, and 95 (63.8%) were adults and 54 (36.2%) were children (age ≤16 years). The most frequently reported drug class was azoles (136; 91.3%). In 31 cases (20.8%) reported by treating physicians, further clinical follow-up information was available. Nearly one-half of these patients were asymptomatic (15/31; 48.4%). In 11 patients (35.5%) among those with symptoms, the symptoms of toxicity were categorised with a strong causality to the respective antifungal. Clinical findings caused by triazoles were effects in the gastrointestinal tract, hallucinations and predelirium state. Clinical findings caused by polyenes were mostly minor symptoms with infusion-related effects or hypokalaemia. The severity was categorised as minor in 6 (54.5%) of 11 cases and as moderate in 5 cases (45.5%). Despite high administered doses, no severe or fatal cases occurred within the study period. Although various toxicities can occur with antifungal administration and overdoses, they showed a favourable safety profile.
Highlights
Systemic antifungals are frequently used for the prevention or therapy of fungal infections [1]
Annual calls related to pharmaceuticals ranged between 6430 to 11 251 (41% to 35% of all calls) in the years 1995 to 2016; 0.07% of all calls related to pharmaceuticals were in association with an antifungal
The data included 149 initial calls, of which approximately two-thirds were among adults (n = 95) and one-third were for children (n = 54) (Table 1)
Summary
Systemic antifungals are frequently used for the prevention or therapy of fungal infections [1]. The incidence of fungal infections has grown in recent decades owing to the increasing prevalence of immunocompromised patients, those with cancer, AIDS (acquired immune deficiency syndrome), au-. Antifungals include diverse classes of medications that are approved for a broad variety of indications, ranging from nail infections and ringworm to fungal meningitis. Antifungals are used to treat invasive fungal infections among transplant recipients, cancer patients and immunodeficient patients. There are several classes of antifungals available, which are classified based on their chemical structure and mechanism of action. These include the polyenes (e.g. amphotericin B and its lipid formulations), azoles (e.g. triazoles and imidazoles), flucytosine and echinocandins (e.g. caspofungin)
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