Vfend talk at Brick Oven last Wed night

Here is what I learned at the talk about Vfend last Wed at Brick Oven. Other pharmacists in attendance were Jeff, Kerry, Ann, and Doug. If you were there please feel free to add to this!

If you have a catheter in you are at risk for fungal infections. Also, if you have a TPN or are immunocompromised.

Candida is the most common fungal infection but now there are many different strains.

If you start the antifungals early you decrease the mortality rate drastically....so it is good to do prophylaxis b/c it can take a few days for the cultures to come back...then you can just dc the antifungal if you don't need it. It is best to start it w/in 12-24 hrs.

Vfend has ALOT of drug interactions. Carbamazepine, phenytoin, rifampin....plus several others I can't remember. So, that is something we can watch out for.

Vfend has EXCELLENT oral bioavailability so if they have a working gut no need for IV.

Vfend works better than Diflucan b/c it works on 2 different pathways and Diflucan just works on one.

If it is an uncomplicated fungal infection use Diflucan b/c it is cheaper.

Other tidbits:

Vancomycin doesn't reach high levels in the lungs so if you have MRSA in the lungs use Zyvox. Zyvox reaches concentrations in the lungs 5-6 x that of vanco.

A common mistake in dosing Vanco is to increase the dose instead of decreasing the frequency. You are not concerned about high peaks but rather a consistent trough of 15-20. So, if it is 1 G q12h and you get a low trough do q8h.

There is no need to use Zosyn for community acquired pneumonia.

He talked about continuous infusion antibiotics, such as Zosyn, and how studies have said it works better but it isn't catching on yet.