title: [Echinocandins: searching for differences. The example of their use in patients requiring continuous renal replacement therapy].
abstract: The echinocandins have a growing role in the treatment of fungal infections because of their novel mechanism of action. This is reflected in recently published management guidelines, but available in vitro data, animal studies, and clinical studies do not clearly differentiate the three agents in class. Comparative clinical efficacy among agents within the class, pharmacokinetic profiles in special populations, pharmacoeconomics justifications, and place in therapy have been largely unanswered. They share many common properties but marketing strategies of drug manufacturers are engaged in product differentiation. Although exist similarities in the pharmacokinetic (PK) profiles of the echinocandins, limited data have been published regarding their pharmacokinetics in continuous renal replacement therapy (CRRT) patients. The pharmacokinetics of drug removal in critically ill patients receiving CRRT is very complex, with multiple variables affecting clearance. This review outlines the basic principles that determine whether a dose adjustment is required. Two studies with data on PK parameters of micafungin and anidulafungin in CRRT patients have been published and are compared following that basic principles in the review.
authors.affiliation: Servicio de Farmacia, Hospital Universitario Miguel Servet, Zaragoza, Spain.
authors.forename: Natalia
authors.initials: N
authors.lastname: de la Llama-Celis
authors.forename: Rafael
authors.initials: R
authors.lastname: Huarte-Lacunza
authors.forename: Cristina
authors.initials: C
authors.lastname: Gómez-Baraza
authors.forename: Iciar
authors.initials: I
authors.lastname: Cañamares-Orbis
authors.forename: Manuel
authors.initials: M
authors.lastname: Sebastián-Aldeanueva
authors.forename: Raquel
authors.initials: R
authors.lastname: Arrieta-Navarro
mesh_terms: D000327:Adsorption; D000935:Antifungal Agents / Q000008:administration & dosage / Q000493:pharmacokinetics* / Q000627:therapeutic use; D000077336:Caspofungin; D016638:Critical Illness; D054714:Echinocandins / Q000008:administration & dosage / Q000493:pharmacokinetics* / Q000627:therapeutic use; D017583:Hemodiafiltration; D006440:Hemofiltration; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000378:metabolism* / Q000628:therapy; D055666:Lipopeptides / Q000493:pharmacokinetics; D008567:Membranes, Artificial; D008657:Metabolic Clearance Rate; D000077551:Micafungin; D009181:Mycoses / Q000150:complications / Q000188:drug therapy*; D017582:Renal Replacement Therapy
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D008567:Membranes, Artificial; D000077336:Caspofungin; D000077551:Micafungin