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.

中文翻译：

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肺曲霉病中抗真菌药物的药理学管理：最新综述

摘要

介绍

曲霉可能导致不同类型的肺部感染：侵袭性、慢性肺部或过敏性支气管肺曲霉病。抗真菌药的药理管理是一项挑战。被诊断患有肺曲霉病的患者很复杂，以及与抗真菌剂相关的问题。

涵盖的领域

本文综述了正在开发和目前用于治疗肺曲霉病的抗真菌药物的药理学，包括作用机制、药代动力学、药效学、剂量、治疗药物监测和安全性。提供了管理日常临床实践中出现的情况的建议。PubMed 的文献检索于2020年 11 月 15^日进行，并于2021年 3 月 30^日更新。

专家意见

肺曲霉病治疗的最新相关进展已经发生。目前正在研究具有新作用机制的新型抗真菌药物，这些药物可扩展抗真菌谱并改善药代动力学相关方面、药物-药物相互作用和安全性。对于已经上市的抗真菌药，有新的药代动力学、药效学、特殊情况下的剂量调整、治疗药物监测和安全性等相关数据。为了最大限度地提高疗效并降低相关毒性的风险，必须选择最合适的抗真菌剂；优化其剂量、间隔、给药途径和治疗时间；并防止副作用。