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Hypoglycemia Following Antifungal Tx in Affected person With Kind 1 Diabetes

Posted in News on 8th November 2018
Micafungin is a member of the echinocandin class of antifungal agents

Micafungin is a member of the echinocandin class of antifungal agents

A recent report published in The Journal of Clinical Endocrinology and Metabolism, describes the case of a patient with type 1 diabetes mellitus (T1DM) who developed hypoglycemia following antifungal therapy for a severe infection.

The 29-year-old female patient had a long history of uncontrolled T1DM and was diagnosed with cervical necrotizing fasciitis with mediastinal spread after presenting for evaluation of worsening dysphagia and dyspnea. Several debridement surgeries as well as broad spectrum antibiotics and antifungal therapy were required to treat her. At admission, she had an HbA1c of 13.4%; due to worsening infection, continuous tube feeds, and multiple surgeries, her insulin needs subsequently increased.

To provide broader antimicrobial coverage, micafungin, a member of the echinocandin class of antifungal agents, was initiated. After administration of micafungin, the patient’s insulin requirement dropped to 0 for more than 48 hours. Upon discontinuing micafungin and switching to a different antifungal, her insulin needs increased again.

“This is the first report of decreased insulin requirements in a patient with T1DM correlating with micafungin administration,” noted the authors. While the exact mechanism by which micafungin induces hypoglycemia has yet to be established, they hypothesized that the agent reduces blood glucose levels through inhibition of sodium-glucose transporter-1 (SGLT1) function.

Antifungal Use Throughout Being pregnant and Danger of Stillbirth: What is the Hyperlink?

Posted in News on 14th June 2018

June 13, 2018

Oral antifungal use during pregnancy is generally not recommended but data has shown 0.5 to 4% of pregnant women still receive this treatment.

Oral antifungal use throughout being pregnant is usually not really useful however knowledge has proven zero.5 to four% of pregnant girls nonetheless obtain this therapy.

Utilizing oral fluconazole throughout being pregnant was not tied to the next threat of stillbirth, in line with a examine revealed in JAMA.

Oral antifungal use throughout being pregnant is usually not really useful however knowledge has proven zero.5 to four% of pregnant girls nonetheless obtain this therapy. Researchers from the Karolinska Institute beforehand discovered that fluconazole use throughout being pregnant was tied to an elevated threat of spontaneous abortion and attainable stillbirth. 

“There are considerations based mostly on animal knowledge that oral fluconazole use in being pregnant could result in fetal loss of life. Given this concern and the paucity of research in people, we wished to analyze the problem additional,” defined lead writer Björn Pasternak, MD, PhD, affiliate professor at Karolinska Institute’s Division of Medication in Solna.

For this examine, Pasternak and colleagues aimed to establish whether or not any fluconazole use throughout being pregnant was related to stillbirth (fetal loss after 22 accomplished weeks) and neonatal loss of life (zero to 27 days after stay beginning). A complete of 10,669 girls from the nationwide Swedish and Norwegian register database have been in comparison with 106,387 girls who didn’t use fluconazole; baseline traits have been comparable between each teams. 

Amongst fluconazole-exposed pregnancies, there have been 2.7 stillbirths per 1000 in contrast with three.6 stillbirths per 1000 amongst unexposed pregnancies (hazard ratio [HR] zero.76, 95% CI, zero.52-1.10). There have been 1.2 neonatal deaths per 1000 uncovered pregnancies and 1.7 neonatal deaths per 1000 unexposed pregnancies (threat ratio [RR] zero.73, 95% CI, zero.42-1.29). 

The info have been comparable for fluconazole doses that have been ≤300mg or >300mg. Extra analyses in line with different covariates confirmed constant outcomes with the first analyses.

Based mostly on the findings, it was concluded that fluconazole use throughout being pregnant was not related to considerably elevated dangers of stillbirth or neonatal loss of life. Nonetheless, the authors cautioned that the boldness intervals have been broad and neither end result was statistically important. 

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“Though the info on fluconazole use in being pregnant recommend no elevated threat of stillbirth, further research needs to be carried out and the collective physique of knowledge scrutinized by drug authorities earlier than advice to information scientific determination making are made, and weighed in opposition to the advantages of remedy,” Dr. Pasternak concluded

For extra info go to jamanetwork.com.

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