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15 Antifungal Pharmacokinetics

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Human Fungal Pathogens

Part of the book series: The Mycota ((MYCOTA,volume 12))

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Abstract

Despite the development of new antifungal drugs, invasive fungal infections are highly prevalent and cause substantial mortality. Adequate individualized treatment is important for improving patient outcomes. This chapter on the pharmacokinetics and pharmacodynamics of the compounds available will help bedside decision-making by addressing, e.g., the tremendous inter- and intra-individual variation and the importance of drug–drug interactions. Nephrotoxicity remains the major challenge of amphotericin B formulations. Echinocandins and amphotericin B show poor penetration into cerebrospinal fluid, brain, and ocular fluid. Voriconazole and fluconazole disseminate into most infection sites including the central nervous system and eye. Recent studies indicate a close relationship between treatment outcome and typical pharmacodynamic indices relative to a pathogen’s minimal inhibitory concentration (MIC). Although the peak concentration (Cmax) to MIC ratio is a good predictive index for the therapeutic efficacy of amphotericin B, for the triazoles the ratio of the area under the concentration–time curve (AUC) to the MIC and trough concentrations are better indices for predicting their therapeutic efficacy.

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Authors and Affiliations

  1. Clinic I for Internal Medizin, Clinical Infectiology, University Hospital Cologne, Cologne, 50924, Germany

    Fedja Farowski

  2. Department I of Internal Medicine, Hospital of the University of Cologne, Kerpener Strasse 62, Köln, 50937, Germany

    Oliver A. Cornely

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  1. Fedja Farowski
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  2. Oliver A. Cornely
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Correspondence to Fedja Farowski .

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Editors and Affiliations

  1. Friedrich Schiller University of Jena, Jena, Germany

    Oliver Kurzai

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Farowski, F., Cornely, O.A. (2014). 15 Antifungal Pharmacokinetics. In: Kurzai, O. (eds) Human Fungal Pathogens. The Mycota, vol 12. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-39432-4_15

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