Muilwijk Eline W, Lempers Vincent J C, Burger David M, Warris Adilia, Pickkers Peter, Aarnoutse Rob E, Brüggemann Roger J M
Department of Pharmacy, Radboud University Medical Center, Nijmegen, The Netherlands.
Expert Rev Anti Infect Ther. 2015 Jun;13(6):799-815. doi: 10.1586/14787210.2015.1028366. Epub 2015 May 6.
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.
棘白菌素类属于抗真菌药物类别。目前，有三种棘白菌素类药物被批准用于静脉治疗侵袭性真菌感染：阿尼芬净、卡泊芬净和米卡芬净。虽然它们的抗真菌活性有重叠，但在药代动力学（PK）方面存在显著差异。许多因素可能导致棘白菌素类药物药代动力学的变异性，包括年龄（儿科与成人）、体表面积和身体组成（正常体重与肥胖）、疾病状态（如重症患者和烧伤患者）以及器官功能障碍（肾和肝功能损害）。暴露改变的后续影响可能会影响疗效和安全性。了解药代动力学行为对于在特定患者或患者群体中优化棘白菌素类药物的临床应用至关重要。本综述提供了关于阿尼芬净、卡泊芬净和米卡芬净在特殊患者群体中药代动力学数据的最新信息。所涉及的患者群体包括新生儿、儿童和青少年、肥胖患者、肝或肾功能损害患者、重症患者（包括烧伤患者）以及血液系统疾病患者。
