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Infect Drug Resist. 2018 May 30;11:805-819. doi: 10.2147/IDR.S165676. eCollection 2018.

Echinocandins for management of invasive candidiasis in patients with liver disease and liver transplantation.

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Department of Pharmacy, National University Health System, Singapore, Singapore.
Department of Pharmacy, National University of Singapore, Singapore, Singapore.
Department of Laboratory Medicine, National University Hospital, Singapore, Singapore.
Global Medical Affairs, Asia-Pacific region, Pfizer, Hong Kong, People's Republic of China.
Medical Affairs, Pfizer Pte. Ltd., Singapore, Singapore.


Candida species remains one of the most important causes of opportunistic infections worldwide. Invasive candidiasis (IC) is associated with considerable morbidity and mortality in liver disease (LD) patients if not treated promptly. Echinocandins are often recommended as a first-line empirical treatment for managing IC and can especially play a critical role in managing IC in LD patients. However, advanced LD patients are often immunocompromised and critically ill. Hence altered pharmacokinetics, drug interactions as well as tolerance issues of antifungal treatments are a concern in these patients. This comprehensive review examines the epidemiology, risk factors and diagnosis of IC in patients with LD and evaluates differences between three available echinocandins for treating this group of patients.


anidulafungin; candidemia; caspofungin; micafungin

Conflict of interest statement

Disclosure Dr. Stephen Lin, Mr. Dennis Yeo and Dr. Sajita Setia are employees of Pfizer, manufacturer of anidulafungin. Mr. Tae Jin Lee underwent indirect patient care pharmacy training for 3 months at Pfizer, Singapore. The other authors report no conflicts of interest in this work.

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