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Sophia Abene is the Assistant Editor for 

. You can email her at abenes@mjhlifesciences.com.

A new human trial aims to prevent the fatal, zoonotic-borne disease.

Vaccine Trial Against Nipah Virus Moves Forward 

A new study warns an increase in costs could lead to new infections.

 Rising Out-of-Pocket Costs for HIV Prevention Medication Threatens Progress

Along with a 1 reported case in Massachusetts, the

New Hampshire Department of Health and Human Services (DHHS) has confirmed a person infected with eastern equine encephalitis (EEE) has died. The public health agency said the person was hospitalized due to severe central nervous system disease. The last reported human EEEV infection in New Hampshire was in 2014, when DHHS identified 3 human infections, including 2 fatalities. In the same statement, DHHS mentions there has been 1 confirmed case in Vermont this summer.

On August 16, the Massachusetts Department of Public Health (MDPH) released a statement discussing the confirmation of the first human case of EEE in the state this year. The confirmed case was discovered in an 80 year old man who was exposed to the vector borne disease in Worcester County. As a result, the risk level in the local communities of Douglas, Oxford, Sutton, and Webster has been raised to critical, and in Dudley, Northbridge, and Uxbridge the risk is increased to high.

Additionally, the neighboring communities of Auburn, Charlton, Grafton, Leicester, Mendon, Millbury, Millville, Southbridge, and Upton are now considered at moderate risk according to MDPH.

“This is the first time we have seen a person infected with EEE in Massachusetts since 2020,” Public Health Commissioner Robbie Goldstein, MD, PhD, said in a statement. “EEE is a rare but serious disease and a public health concern. We want to remind residents of the need to protect themselves from mosquito bites, especially in areas of the state where we are seeing EEE activity.

Though very rare, EEE is serious and a potentially fatal disease that can affect people of all ages. EEE is generally spread to humans through the bite of an infected mosquito. There were 12 human cases of EEE in Massachusetts in 2019 with 6 deaths, and 5 human cases with 1 death in 2020. There were no human cases of EEE in Massachusetts in 2021, 2022, or 2023.

EEE has a fatality rate of 33% to 70%, with most deaths occurring 2–10 days after the onset of symptoms.

In addition to a high mortality rate, long-term physical and mental complications, including permanent neurological deficits have been identified in many people who survive EEE.

Plymouth is approximately 40 miles south of Boston along the coast, and Worcester County is in the middle of the state, so the 2 areas are not in close proximity, but due to the elevated risk locally, the town of Plymouth decided to take action in response to outdoor parks. As of last Friday, all town public parks and fields are close daily from dusk until dawn.

“As Mass DPH has now elevated Plymouth’s EEE risk status to high, it is important to take extra precautions when outdoors and follow state and local health guidelines to avoid unnecessary risk to exposure to EEE. The health and safety of our community, residents, and visitors remain our priority,” Plymouth’s Commissioner of Health and Human Services, Michelle Bratti, said in a statement.

According to the Centers for Disease Control and Prevention (CDC) most people who are infected with the virus do not develop symptoms; however, for those that do, the date from the bite to the onset of the illness is 4 to 10 days. EEE can also result in fever or neurologic disease. The type of illness will depend on the age of the person and other factors. Those who are infected can develop meningitis.

There are no FDA-approved treatments for EEE and for patients who develop severe cases, they can be hospitalized to receive supportive treatment.

Over the weekend, MDPH detailed plans of spraying for mosquitos including aerially in areas of Plymouth County, and truck-mounted spraying in parts of Worcester County. As of Saturday, 10 communities in Massachusetts were raised to high or critical risk for EEE virus.

“The risk from EEE is high in parts of Plymouth County and critical in parts of Worcester County,” State Epidemiologist Catherine M. Brown, DVM, said in a statement. “In addition to recommending that people use mosquito repellent with an EPA-registered active ingredient and clothing to reduce exposed skin, we also recommend that evening outdoor events be rescheduled to avoid the hours between dusk and dawn. The mosquitoes most likely to spread EEE are most active during the dusk to dawn hours.”

There are preventative strategies to avoid EEE, and the MDPH has listed such measures 

For those who live in Massachusetts and want more information on EEE, it can be found 

 or by calling the DPH Division of Epidemiology at 617-983-6800.

1.NH DHHS Identifies Person Infected with Eastern Equine Encephalitis Virus in New Hampshire.The New Hampshire Department of Health and Human Services. August 27, 2024. Accessed August 28, 2024.
https://www.dhhs.nh.gov/news-and-media/nh-dhhs-identifies-person-infected-eastern-equine-encephalitis-virus-new-hampshire
2. State health officials announce season’s first human case of Eastern Equine Encephalitis in Massachusetts. MDPH. August 16, 2024. Accessed August 27, 2024.
https://www.mass.gov/news/state-health-officials-announce-seasons-first-human-case-of-eastern-equine-encephalitis-in-massachusetts
3.Plymouth to Close all Public Parks and Fields from Dusk to Dawn. Town of Plymouth. August 23, 2024. Accessed August 27, 2024. PDF.
4. Eastern Equine Encephalitis: Symptoms, Diagnosis, and Treatment. CDC. May 15, 2024. Accessed August 27, 2024.
https://www.cdc.gov/eastern-equine-encephalitis/symptoms-diagnosis-treatment/index.html
5. State officials announce plans to spray for mosquitoes in sections of Worcester and Plymouth counties due to EEE. MDPH. August 24, 2024. Accessed August 27, 2024. 
https://www.mass.gov/news/state-officials-announce-plans-to-spray-for-mosquitoes-in-sections-of-worcester-and-plymouth-counties-due-to-eee



The town of Plymouth decided to prohibit people from using the parks from dusk to dawn due to concerns over eastern equine encephalitis after a man contracted the rare disease in the state.

Concerns Over Mosquito-Borne Illness Causes Massachusetts Town to Create Curfew for Parks, Spraying in Counties

David W. Denning outlines the "95-95 by 2025" initiative, aiming to diagnose and treat 95% of serious fungal infections globally by 2025, with a focus on improving access in underserved regions.

Fungal Infections: Invisible Until It’s Too Late

In 2015, fungal infections affected over 1 billion people globally each year, leading to an estimated 11.5 million life-threatening infections and more than 1.5 million deaths annually. Despite their significant impact, fungal diseases have historically been under-recognized and underfunded in global health efforts. In response, the Global Action Fund for Fungal Infections (GAFFI) launched a global initiative called "95-95 by 2025," which aims to diagnose and treat 95% of individuals with serious fungal infections by the end of 2025.

David W Denning, FRCP, FRCPath, FMedSci, professor of infectious diseases and global health at the University of Manchester, played a key role in developing GAFFI’s initiatives. Denning, also former chief executive of GAFFI, discussed the challenges of diagnosing and treating fungal infections and the goals of the 95-95 by 2025 initiative.

“We convened a meeting alongside one of the International AIDS meetings in Seattle in 2015 with about 60-70 people, including people from all over the world,” Denning said. “Some from Africa, South America, Asia, as well as people from the WHO and other major funding agencies to address the problem of how we're going to stop people dying of fungal disease. One of the problems with fungal disease is that it’s fairly invisible until it’s too late. You have to start looking for it in at-risk patients. So, examples of patients with AIDS, patients who have a transplant, patients with really complicated lung disease, patients with leukemia, lymphoma, that sort of group of patients."

Denning highlighted the lack of diagnostic infrastructure in many regions, particularly in Sub-Saharan Africa and Asia. He noted, “We learned that many countries, particularly in Sub-Saharan Africa, but also in many parts of Asia, don’t have a diagnostic service for fungal disease, and many of them don’t have any of the modern treatments for fungal disease. So, we ended up writing a roadmap that included a very basic summary of how many infections there might be in the world with these problems, and also the approaches, the diagnostics, and the treatments that are relevant to that."

Denning explained their goal, “Our aspiration 10 years ago now was that 95% of the world's population would have access to these diagnostics, and 95% would have access to the relevant anti-fungal therapies, particularly the generic anti-fungal therapies that are less expensive than the more recently issued ones."

Denning discussed the barriers to achieving this goal, including drug approval delays and the lack of resources in many countries. Denning explained, “For example, in South Africa, 

 was on the roster for approval for five years before they finally approved it, and yet it’s a core drug for fungal meningitis in AIDS. As you know, South Africa has the largest population of HIV patients per capita in the world.”

Denning noted that these delays are just one example of the challenges in ensuring access to affordable treatments. He said, “There are lots of different tests. There's lots of different lab approaches to handling those tests, and the registration processes for drugs are complicated in many countries.”

Denning discussed the progress made in countries like Guatemala, where GAFFI helped fund a project in 13 centers across the country. Denning described the process, “In Guatemala, we funded a small demonstration project and helped run it with about 13 centers across the country looking after patients with HIV and AIDS. We provided the wherewithal for them to run a rapid diagnostic service for two important fungal infections which are common: histoplasmosis and cryptococcal meningitis, in tandem with diagnostics for TB, which is also common there.”

The program successfully improved diagnostic accuracy, reduced misdiagnosis of tuberculosis as fungal infections, and ultimately led to a decrease in mortality. Denning shared, “We diagnosed many fungal infections, we diagnosed fewer TB infections, and that was because they were misdiagnosed as TB when actually they were a fungus. The overall mortality from these late-stage patients went down by 8% in basically two and a half years. And that’s a really big change.”

Denning expressed hope that similar programs could be replicated in other regions facing similar challenges, “We’d like to reproduce that other places. The idea here was to show that if you applied these diagnostics, and you provided the results quickly, and you trained the clinicians in parallel, you could really make a difference.”

Stay tuned for the next part of our conversation where we dive deeper into the initiative.

1. Denning DW. The ambitious '95-95 by 2025' roadmap for the diagnosis and management of fungal diseases. Thorax. 2015;70(7):613-614. doi:10.1136/thoraxjnl-2015-207305

2. Gaffi. IMPROVING OUTCOMES FOR PATIENTS WITH FUNGAL INFECTIONS ACROSS THE WORLD A ROAD MAP FOR THE NEXT DECADE. February 2025. Accessed January 20, 2025. chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://gaffi.org/wp-content/uploads/GAFFI_Road_Map_interactive-final0415.pdf

David W Denning, FRCP, FRCPath, FMedSci, outlines the "95-95 by 2025" initiative to diagnose and treat 95% of serious fungal infections globally by 2025, focused on improving access in underserved regions.





Obesity is a worldwide epidemic and widespread in the US, affecting over one third of the population. According to the Centers for Disease Control and Prevention (CDC), all US states have an obesity prevalence that exceeds 20% and obesity disproportionately affects certain geographic, socioeconomic, ethnic, and racial groups.

 Obesity is an independent risk factor for various types of infections as well as poorer infection-associated clinical outcomes.

Obesity has significant effects on the pharmacokinetics (PK) of various anti-infective drugs, including antifungals, with two of the most important being volume of distribution (Vd) and clearance. Vd generally increases with obesity as a result of increased adipose and lean tissue mass, particularly for lipophilic and highly protein bound drugs. This increased Vd may necessitate higher individual doses and, in particular, loading doses. Additionally, wider variability may be seen in overall exposure in obese patients for drugs dosed by weight, increasing risk of both over- and underdosing. Clearance may be increased in obese patients due to increased renal mass and renal blood flow. However, clearance can also be affected by comorbid conditions associated with obesity like chronic kidney or liver disease. Variations in the clearance of obese patients may affect maintenance dosing requirements.

 species and exhibit free-drug 24-hour area under the curve relative to the organism mean inhibitory concentration (

AUC/MIC targets were originally established in murine models then subsequently validated in retrospective human studies. Species-specific targets for echinocandins are 

This review aims to provide echinocandin dosing considerations in obese patients from the available literature.

Anidulafungin demonstrates linear PK with typical doses and protein binding approximating 99%.

 Anidulafungin is generally given intravenously (IV) as a loading dose of 200 mg followed by a maintenance dose of 100 mg daily for most indications and 200 mg daily for endocarditis or cardiac device infections.

 Anidulafungin clearance is unique amongst the echinocandins in that it undergoes non-hepatic spontaneous biodegradation.

Liu et al studied pooled patients from phase 2 and 3 clinical trials to assess the impact of obesity on clinical outcomes and anidulafungin PK parameters. Included for analysis were 262 patients. Weight was found to be modestly negatively associated with decreased AUC but not to a clinically significant degree. When comparing patients at the extremes of weight (40 kg vs. 150 kg), similar clinical efficacy and safety outcomes were observed.

 Hutton et al, in a retrospective study of 173 critically ill patients with candidemia treated with anidulafungin, found no difference in mortality between obese and non-obese patients.

Other PK analyses have shown variable results. Wasmann et al, in a single-dose PK study of 20 healthy obese and non-obese volunteers found that obese patients had a lower AUC due to increased clearance and Vd, though these patients did not have clinical disease.

 Similarly, Luque et al in 23 critically ill patients with invasive fungal infections and Dowell et al in 225 patients with serious fungal infections found weight was positively associated with clearance.

 Conversely, Liu et al in a population PK study of 454 patients with invasive aspergillosis and Bruggemann et al in a PK study of 36 critically ill patients with invasive fungal infections found no effect between weight on anidulafungin PK.

In summary, multiple clinical studies have found no difference in clinical outcomes between obese and non-obese patients treated with anidulafungin. Additionally, PK studies have had mixed findings and even those with detectable signals have acknowledged unclear clinical significance. Thus, the data does not appear to support dose adjustments of anidulafungin for obese patients.

Caspofungin generally displays linear PK with conventional doses and protein binding is high, exceeding 90%.

 Caspofungin is traditionally given as a loading dose of 70 mg IV once followed by a 50 mg IV daily maintenance dose thereafter. A higher dosing regimen of 150 mg daily is used for endocarditis or cardiac device infections.

 Caspofungin, similar to other echinocandins, is generally well tolerated even at higher doses (ie, 150 mg daily).

Ryan et al performed a post hoc pooled analysis of patients from phase 3 and 3 clinical trials of caspofungin to assess comparative efficacy and safety between obese and non-obese patients. In total, 1,134 patients across nine trials were evaluated, 163 (14%) were obese and 312 (28%) were overweight. The authors found no difference in clinical success and adverse drug reactions between obese and non-obese patients. This effect held true for studies of esophageal candidiasis, invasive candidiasis, and empirical therapy. There was a signal towards poorer outcomes in studies of invasive aspergillosis, though this is not a condition for which echinocandins are generally used as monotherapy.

Findings from PK studies of caspofungin in obese patients have been inconsistent. Two dose ranging studies conducted by Wurthwein et al and Muilwjik et al demonstrated either no impact or a detectable but clinically insignificant impact of weight on caspofungin clearance for doses between 50 to 200 mg daily. Of note, Wurthwein et al did find a 20% lower caspofungin AUC in patients weighing 80 kg vs those weighing 60 kg but this was not assessed to be sufficiently clinically meaningful given pharmacodynamic targets were still met. Both studies concluded that standard caspofungin dosing may be adequate for obese patients.

However, 2 subsequently published PK studies had opposing findings. van der Elst et al in an analysis of 20 critically ill patients found a positive association between weight (defined overweight as ≥80 kg) and caspofungin clearance as well as Vd. Based on these findings, the authors recommended a weight-based dosing regimen of 1 mg/kg/day.

 Martson et al in a study of 15 critically ill patients found a similar association (defined overweight as ≥120 kg) and recommended a loading dose of 2 mg/kg followed by a maintenance dose of 1.25 mg/kg/day to optimize AUC.

Taken together, there does not appear to be strong clinical evidence to support universally increasing dosing of caspofungin in obese patients. Obesity does not appear to impact clinical outcomes for patients with invasive and non-invasive candidiasis treated with caspofungin. That said, findings from PK analyses suggest risk of inadequate exposure, particularly in critically ill obese patients. Given the reliable safety profile of caspofungin and lack of dose-dependent toxicity in doses up to 150 mg daily, clinicians may consider a modest dose increase (eg, 70 mg daily) on a case-by-case basis in critically ill patients with severe candida infections receiving 50 mg daily dosing. A referenceable weight cutoff is used by the European Medicines Agency, which recommends using a maintenance dose of 70 mg daily (instead of 50 mg daily) in patients weighing 80 kg or greater.

Micafungin, the most commonly used echinocandin in clinical practice, exhibits linear PK and has high protein binding at >99%.

 PK/pharmacodynamic (PD) targets have been defined in patients with invasive candidiasis or candidemia based on AUC/MIC ratio.19 Micafungin is generally dosed at 100 – 150 mg IV every 24 hours with 150 mg designated for esophageal candidiasis. Data from two randomized, controlled phase 3 clinical trials found an AUC/MIC ratio breakpoint between 5,000 and 12,000 to have a 98% success rate for all 

Only one study has assessed the impact of obesity on micafungin clinical effectiveness.

 In this retrospective cohort study of 132 adult patients, no significant difference in clinical improvement or all-cause mortality was observed between obese and non-obese patients who received micafungin or caspofungin. The authors concluded further research in prospective, multicenter, larger study populations is needed.

While only one study assessed clinical outcomes, six PK studies have been completed that will be briefly summarized.

 Of these studies, four recommend micafungin dose increases with variations on the use criteria. Gumbo et al evaluated 62 hematopoietic cell transplant patients and concluded that patients with weight > 66.3 kg had increased clearance and decreased AUC, thus recommending 150 mg/day if above this weight cutoff.

Interestingly, while providing a cutoff based on weight, the findings were lower than obesity definitions. This could be augmented renal clearance due to the population or other factors that impact PK discussed later in the review. Hall et al utilized PK data from 36 healthy volunteers and recommend, similarly to Gumbo et al, dose increases in patients with weight 

 66 kg. Interestingly, they found a poor correlation between BMI and clearance of micafungin.

 Maseda et al performed a PK/PD study to evaluate probability of micafungin AUC/MIC target attainment in obese and morbidly obese ICU patients. BMI for all patients was > 45 kg/m2. Upon Monte Carlo simulation, the authors showed that the standard 100 mg micafungin dosing provided inadequate coverage for 

species. They recommend specific dosing based on 

, they recommend 150 mg/day for obese patients up to 115 kg and 200 mg/day in patients over 115 kg. For 

, the recommendation is 200 mg/day for obese patients up to 115 kg, but no recommendation for patients > 115 kg.

 Lastly, Wasmann et al investigated 24 healthy volunteers with BMI > 40 kg/m2 and found increased clearance, Vd, and low AUC. The following recommendations were provided in order to reach micafungin’s PD target: for patients > 125 kg and infected 

species with a micafungin MIC of 0.016 µg/mL provide a dose of 200 mg/day; while if the MIC is 0.032 µg/mL, increase the micafungin dose to 300 mg/day.

Controversially, Tabata et al and Lempers et al both performed PK studies and concluded micafungin dose increases were not necessary.

 Tabata et al evaluated 179 patients and healthy volunteers and found that increasing weight was not associated with a reduction in micafungin exposure.

 Similarly, Lempers et al conducted a small PK study of 20 ICU patients and found micafungin PK values including clearance, Vd, and AUC, were not impacted by weight or BMI. 

In summary, the majority of the studies have shown lower exposures of micafungin in obese patients, but the one available clinical study found no impact on clinical outcomes reported. Clinicians can utilize these studies to tailor micafungin dosing to their patients' characteristics such as weight and infecting 

species, however, further research on patient outcomes is needed.

Rezafungin is a novel echinocandin with a prolonged half-life of ~133 hours allowing for extended-interval dosing; the approved dosing scheme includes a 400 mg loading dose IV followed by 200 mg IV weekly infusions. Few studies are currently available, however a poster abstract presented at IDWeek 2020 by Vazquez et al utilized STRIVE Phase 2 study data to evaluate outcomes stratified by BMI (< 30 or 

 Overall response, mycological response, and investigator assessment of clinical cure was similar between the two groups with no concerning safety trends observed. However, following one dose of rezafungin 400 mg, the ranges of AUCs by BMI category observed a minor mean difference of ~20%, lower for those with BMI 

 30 kg/m2. Regardless, the authorship concluded from these results that dose adjustments in obese patients are not necessary. Initial findings follow similarly to other echinocandins with no signal of decreased clinical efficacy, but PK evaluation suggests lower exposure with elevated BMIs. More data is needed as rezafungin is incorporated further into clinical practice. 

Could TDM optimize targeted dosing rather than “a one dose fits all” approach for obese patients? Overall, TDM data is sparse. Evaluation of AUC/MIC has been suggested by models, however utilization in patients is lacking.

 Vena et al evaluated troughs via high performance liquid chromatography for micafungin, anidulafungin, and caspofungin.

 Target therapeutic trough goal was set to > 1µg/mL based on findings from Stone et al.

 They demonstrated that levels were variable between patients, however, patients with troughs at their designated target were associated with favorable clinical outcomes.

 As of yet, there is insufficient evidence to recommend when to utilize TDM and further studies are needed.

Additional considerations for increasing echinocandin doses aside from obesity do exist. Critical illness, continuous renal replacement therapy (CRRT), and extracorporeal membrane oxygenation (ECMO) have been identified in literature.

 For example, sequestration by membrane adsorption within the ECMO circuit causes increased Vd and thus lowers exposure. Increased dosing of micafungin has been suggested at 200 mg/day in these situations.

 In such cases, TDM may be of added value, but this has not been studied. Also of note, high doses of echinocandins have been shown to be well-tolerated at increased doses.

 Consideration of the patient in entirety is crucial for optimal care and dosing considerations and although conflicting data, the cons (safety and tolerability) are little to none.

Notably for this review, while controversial findings have previously been described regarding patient outcomes, obesity has been associated with worse outcomes in patients with invasive candidiasis. In a retrospective cohort study of patients with candidemia conducted by Barber et al, obese patients had longer durations of treatment, infection-related length of stay, and duration of candidemia though no differences in mortality of readmissions were found.

 Thus, the astute clinician should appreciate that other factors beyond PK/PD may influence outcomes in obese patients with invasive candidiasis treated with echinocandins.

In this review we have found that while there is robust PK evidence of decreased echinocandin exposure in obese patients, clinical outcomes have not been shown to be significantly affected. However, many of the studies had small sample sizes or various limitations. Due to echinocandins favorable safety profile and tolerability, clinicians should evaluate their patients' on a case-by-case basis on whether to utilize higher dosing. This review provides suggestions from available literature to accompany clinical judgement in providing personalized dosing of echinocandins in obese patients.

The Society of Infectious Diseases Pharmacists (SIDP) is an association of pharmacists and other allied healthcare professionals who are committed to promoting the appropriate use of antimicrobial agents and supporting practice, teaching, and research in infectious diseases. We aim to advance infectious diseases pharmacy and lead antimicrobial stewardship in order to optimize the care of patients. To learn more about SIDP, visit 

1.Prevention CDC. Adult Obesity Prevalence Maps. Accessed 9/16, 2024. https://www.cdc.gov/obesity/php/data-research/adult-obesity-prevalence-maps.html

2.Pugliese G, Liccardi A, Graziadio C, Barrea L, Muscogiuri G, Colao A. Obesity and infectious diseases: pathophysiology and epidemiology of a double pandemic condition. Int J Obes (Lond). Mar 2022;46(3):449-465. doi:10.1038/s41366-021-01035-6

3.Meng L, Mui E, Ha DR, Stave C, Deresinski SC, Holubar M. Comprehensive guidance for antibiotic dosing in obese adults: 2022 update. Pharmacotherapy. Mar 2023;43(3):226-246. doi:10.1002/phar.2769

4.Pea F, Lewis RE. Overview of antifungal dosing in invasive candidiasis. J Antimicrob Chemother. Jan 1 2018;73(suppl_1):i33-i43. doi:10.1093/jac/dkx447

5.Muilwijk EW, Lempers VJ, Burger DM, et al. Impact of special patient populations on the pharmacokinetics of echinocandins. Expert Rev Anti Infect Ther. Jun 2015;13(6):799-815. doi:10.1586/14787210.2015.1028366

6.Pappas PG, Kauffman CA, Andes DR, et al. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis. Feb 15 2016;62(4):e1-50. doi:10.1093/cid/civ933

7.Liu P. Population pharmacokinetic-pharmacodynamic analysis of anidulafungin in adult patients with fungal infections. Antimicrob Agents Chemother. Jan 2013;57(1):466-74. doi:10.1128/AAC.01473-12

8.Hutton M, Kenney RM, Vazquez JA, Davis SL. Influence of Body Weight Category on Outcomes in Candidemia Patients Treated With Anidulafungin. J Pharm Pract. Feb 2022;35(1):20-25. doi:10.1177/0897190020938219

9.Wasmann RE, Ter Heine R, van Dongen EP, et al. Pharmacokinetics of Anidulafungin in Obese and Normal-Weight Adults. Antimicrob Agents Chemother. Jul 2018;62(7)doi:10.1128/AAC.00063-18

10.Dowell JA, Knebel W, Ludden T, Stogniew M, Krause D, Henkel T. Population pharmacokinetic analysis of anidulafungin, an echinocandin antifungal. J Clin Pharmacol. Jun 2004;44(6):590-8. doi:10.1177/0091270004265644

11.Luque S, Hope W, Campillo N, et al. Population Pharmacokinetics of Anidulafungin in Critically Ill Patients. Antimicrob Agents Chemother. Jul 2019;63(7)doi:10.1128/AAC.00378-19

12.Bruggemann RJ, Middel-Baars V, de Lange DW, et al. Pharmacokinetics of Anidulafungin in Critically Ill Intensive Care Unit Patients with Suspected or Proven Invasive Fungal Infections. Antimicrob Agents Chemother. Feb 2017;61(2)doi:10.1128/AAC.01894-16

13.Liu P, Mould DR. Population pharmacokinetic analysis of voriconazole and anidulafungin in adult patients with invasive aspergillosis. Antimicrob Agents Chemother. Aug 2014;58(8):4718-26. doi:10.1128/AAC.02808-13

14.Ryan DM, Lupinacci RJ, Kartsonis NA. Efficacy and safety of caspofungin in obese patients. Med Mycol. Oct 2011;49(7):748-54. doi:10.3109/13693786.2011.571293

15.Wurthwein G, Cornely OA, Trame MN, et al. Population pharmacokinetics of escalating doses of caspofungin in a phase II study of patients with invasive aspergillosis. Antimicrob Agents Chemother. Apr 2013;57(4):1664-71. doi:10.1128/AAC.01912-12

16.van der Elst KC, Veringa A, Zijlstra JG, et al. Low Caspofungin Exposure in Patients in Intensive Care Units. Antimicrob Agents Chemother. Feb 2017;61(2)doi:10.1128/AAC.01582-16

Obesity significantly impacts the pharmacokinetics (PK) of antifungal drugs like echinocandins, including volume of distribution (Vd) and clearance. However, despite these PK differences, current clinical evidence generally does not support the need for universal dose adjustments in obese patients. Clinicians should consider personalized dosing based on patient characteristics, infection severity, and specific drug properties due to echinocandins' favorable safety profiles.

Sophia Abene

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