Impact of special patient populations on the pharmacokinetics of echinocandins

Eline W. Muilwijk, Vincent J. C. Lempers, David M. Burger, Adilia Warris, Peter Pickkers, Rob E. Aarnoutse, Roger J. M. Bruggemann*

*Corresponding author for this work

Research output: Contribution to journalLiterature reviewpeer-review

35 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)799-815
Number of pages17
JournalExpert Review of Anti-infective Therapy
Issue number6
Publication statusPublished - 6 May 2015


  • anidulafungin
  • caspofungin
  • critically ill
  • hematology
  • invasive fungal infection
  • micafungin
  • obesity
  • organ dysfunction
  • pediatrics
  • pharmacokinetics
  • critically-ill patients
  • stem-cell transplantation
  • extracorporeal membrane-oxygenation
  • continuous venovenous hemofiltration
  • multiple-dose pharmacokinetics
  • escmid-asterisk guideline
  • renal replacement therapy
  • liposomal amphotericin-B
  • azole antifungal drugs
  • birth-weight infants


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