Echinocandin exposures in obese patients: A scoping review and clinical perspectives.

This article focuses on the pharmacokinetic (PK) exposures of echinocandin antifungal drugs in obese patients and the implications for dosing adjustments. A scoping review of 25 studies involving over 3,174 subjects found that 17 studies reported lower echinocandin exposures in overweight and obese individuals compared to normal-weight individuals, suggesting potential underdosing, while 8 studies found no significant differences. Echinocandins, including anidulafungin, caspofungin, micafungin, and the investigational rezafungin, are key treatments for invasive fungal infections, but obesity-related physiological changes may alter drug clearance and volume of distribution, leading to reduced drug exposure. Despite some recommendations for dose increases in obese patients, there is currently insufficient high-quality evidence to establish standardized dosing guidelines, highlighting the need for further research to optimize echinocandin therapy in this population.