title: Impact of special patient populations on the pharmacokinetics of echinocandins.
abstract: Echinocandins belong to the class of antifungal agents. Currently, three echinocandin drugs are licensed for intravenous treatment of invasive fungal infections: anidulafungin, caspofungin and micafungin. While their antifungal activity overlaps, there are substantial differences in pharmacokinetics (PK). Numerous factors may account for variability in PK of echinocandins including age (pediatrics vs adults), body surface area and body composition (normal weight vs obesity), disease status (e.g., critically ill and burn patients) and organ dysfunction (kidney and liver impairment). Subsequent effects of altered exposure might impact efficacy and safety. Knowledge of PK behavior is crucial in optimal clinical utilization of echinocandin in a specific patient or patient population. This review provides up-to-date information on PK data of anidulafungin, caspofungin and micafungin in special patient populations. Patient populations addressed are neonates, children and adolescents, obese patients, patients with hepatic or renal impairment, critically ill patients (including burn patients) and patients with hematological diseases.
authors.affiliation: Department of Pharmacy, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Eline W
authors.initials: EW
authors.lastname: Muilwijk
authors.forename: Vincent J C
authors.initials: VJ
authors.lastname: Lempers
authors.forename: David M
authors.initials: DM
authors.lastname: Burger
authors.forename: Adilia
authors.initials: A
authors.lastname: Warris
authors.forename: Peter
authors.initials: P
authors.lastname: Pickkers
authors.forename: Rob E
authors.initials: RE
authors.lastname: Aarnoutse
authors.forename: Roger J M
authors.initials: RJ
authors.lastname: Brüggemann
mesh_terms: D000293:Adolescent; D000328:Adult; D000077612:Anidulafungin; D000935:Antifungal Agents / Q000627:therapeutic use*; D002175:Candida / Q000187:drug effects; D000077336:Caspofungin; D002648:Child; D016638:Critical Illness; D004347:Drug Interactions; D054714:Echinocandins / Q000009:adverse effects / Q000493:pharmacokinetics*; D006402:Hematologic Diseases / Q000503:physiopathology; D006801:Humans; D007231:Infant, Newborn; D007668:Kidney / Q000503:physiopathology; D055666:Lipopeptides / Q000009:adverse effects / Q000493:pharmacokinetics*; D008099:Liver / Q000503:physiopathology; D000077551:Micafungin; D008826:Microbial Sensitivity Tests; D009765:Obesity
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D000077612:Anidulafungin; D000077336:Caspofungin; D000077551:Micafungin
keywords: anidulafungin; caspofungin; critically ill; hematology; invasive fungal infection; micafungin; obesity; organ dysfunction; pediatrics; pharmacokinetics