Clinical Microbiology and Antimicrobial Chemotherapy. 2009; 11(3):264-274
Invasive candidiasis is a third or fourth cause of sepsis in intensive care units (ICUs). Clinical and pharmacoeconomic study of treatment for invasive candidiasis was first performed using mathematical modeling in Russian economic environment. ICU patients without neutropenia who have received primary prophylaxis with azoles and/or patients from ICUs with the high rate (>20%) of fluconazole resistance in Candida (based on data from national or local studies) were used in the model. Use of caspofungin or amphotericin B was analyzed as a model of initial therapy for invasive candidiasis. If the initial treatment with amphotericin B was failed then the use of caspofungin or amphotericin B lipid complex was analyzed. If the initial treatment with caspofungin was failed then the use of amphotericin B lipid complex was analyzed. Alternative scenario was also tested, and one-sided sensitivity analysis was performed. Results of the study showed that amphotericin B with change to caspofungin (in cases of treatment failure or severe adverse events) was the most appropriate initial therapy of invasive candidiasis at high rate of resistance to fluconazole in Candida spp.