Antimicrobial dosing considerations in critically ill patients with acute kidney injury: A review

Table 3 Pharmacokinetic/pharmacodynamic profiles and continuous kidney replacement therapy dosing recommendations for selected antifungals

Antifungals	PK/PD index	PK profile	Renal clearance (%)	Suggested CKRT dosing
Echinocandins[99]
Anidulafungin	AUC24/MIC	MW: 1140.3; PB: > 99%; Vd: 30-50 L	< 1	No dosage adjustment necessary (poorly dialyzed)
Caspofungin	AUC24/MIC	MW: 1213.42; PB: 97%; Vd: 9.7 L	Approximately 1% of total dose as unchanged drug	No dosage adjustment necessary (poorly dialyzed)
Micafungin	AUC24/MIC	MW: 1292.26; PB: > 99%; Vd: 0.39 L/kg	< 1	No dosage adjustment necessary (poorly dialyzed)
Azoles
Fluconazole	AUC24/MIC	MW: 306; PB: 11%-12%; Vd: 0.6 L/kg	80%	For recommended dose of 400 mg once daily, to give 800 mg loading dose, followed by maintenance doses of 800 mg/day in 1 to 2 divided doses
Voriconazole	AUC24/MIC	MW: 349; PB: 58%; Vd: 4.6 L/kg	< 2	No dosing adjustment necessary
Isavuconazole	AUC24/MIC	MW: 437; PB: > 99%; Vd (IV): 450 L	< 1	No dosing adjustment necessary
Polyenes
Amphotericin B deoxycholate	Cmax/MIC	MW: 924; PB: 90%; Vd: 4 L/kg	< 5	No dosage adjustment necessary (unlikely dialyzed)

Pharmacokinetic/pharmacodynamic profiles and continuous kidney replacement therapy dosing recommendations for selected antifungals[98]. Drug dosing from UpToDate unless otherwise specified. Molecular weight units are in Daltons. PK: Pharmacokinetic; PD: Pharmacodynamic; CKRT: Continuous kidney replacement therapy; MIC: Minimum inhibitory concentration; MW: Molecular weight; Vd: Volume of distribution; C_max: Maximal plasma concentration; AUC24/MIC: 24-hour area under the concentration time curve to minimum inhibitory concentration.