Cornely Oliver A, Dupont Hervé, Mikulska Malgorzata, Rautemaa-Richardson Riina, Garcia-Vidal Carolina, Thompson George R, Hoenigl Martin
University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, Germany; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.
Department of Anaesthesiology and Critical Care Medicine, Amiens-Picardie University Hospital, Amiens, France.
J Infect. 2025 Mar;90(3):106435. doi: 10.1016/j.jinf.2025.106435. Epub 2025 Feb 5.
Achieving and maintaining therapeutic drug exposures with antifungals can be challenging in special patient populations, such as those with organ dysfunction (liver or kidney) or obesity, or elderly patients, due to dose-exposure relationships and potential drug-drug interactions. Dose adjustments may be needed in these populations to maintain therapeutic efficacy and/or prevent toxicity. We reviewed specific dosing considerations for antifungals in special populations with candidaemia and/or invasive candidiasis, focusing on those relating to echinocandins (based on prescribing information), and then explored the utility of the second-generation echinocandin rezafungin in treating these populations (based on currently available data identified from a PubMed and congress abstract search). Available data showed that echinocandins may sometimes require dosing modifications for special populations with candidaemia/invasive candidiasis, primarily due to decreases in pharmacokinetic exposures. Rezafungin appears to be suitable for use in a variety of special populations without the need for dose modifications based on available data, including patients with organ dysfunction or obesity, and elderly and critically ill patients. Further research is needed in populations where rezafungin data are not available including children, people living with HIV, patients receiving extracorporeal membrane oxygenation and those with underlying neurological conditions.
在特殊患者群体中，如存在器官功能障碍（肝脏或肾脏）、肥胖的患者或老年患者，由于剂量-暴露关系以及潜在的药物相互作用，实现并维持抗真菌药物的治疗性药物暴露可能具有挑战性。在这些人群中可能需要调整剂量，以维持治疗效果和/或预防毒性。我们回顾了念珠菌血症和/或侵袭性念珠菌病特殊人群中抗真菌药物的具体给药注意事项，重点关注与棘白菌素类（基于处方信息）相关的注意事项，然后探讨了第二代棘白菌素瑞扎芬净在治疗这些人群中的效用（基于从PubMed和会议摘要搜索中确定的现有数据）。现有数据表明，对于念珠菌血症/侵袭性念珠菌病特殊人群，棘白菌素类有时可能需要调整给药方案，主要是由于药代动力学暴露量降低。基于现有数据，瑞扎芬净似乎适用于各种特殊人群，无需调整剂量，包括器官功能障碍或肥胖患者、老年患者和重症患者。在缺乏瑞扎芬净数据的人群中，包括儿童、艾滋病毒感染者、接受体外膜肺氧合的患者以及患有基础神经系统疾病的患者，还需要进一步研究。
