TABLE 2.

Pharmacodynamic properties of selected antifungal agents as determined by in vitro time-kill methods

Antifungal agent	Organism	Pharmacodynamic characteristics	Comments	References
Amphotericin B	Candida spp.; C. neoformans	Concentration-dependent fungicidal activity; PAFE, >12 h	Confirmed by in vivo studies; optimal peak/MIC is 4	2, 17, 34, 66
Echinocandins (anidulafungin, caspofungin, micafungin)	Candida spp.	Concentration-dependent fungicidal activity; PAFE, >12 h	Not fungicidal against all strains tested; rate and extent of fungicidal activity are medium dependent; confirmed by in vivo studies; optimal peak MIC is 3-4	2, 17-19, 66
Fluconazole	Candida spp.; C. neoformans	Concentration-independent fungistatic effect; no PAFE	Confirmed by in vivo studies; optimal response observed when AUC/MIC is 25; concentration of >4× MIC not associated with additional antifungal activity	2, 17, 66
Voriconazole, posaconazole, ravuconazole	Candida spp.; C. neoformans	Concentration-independent fungistatic effect; no PAFE	Confirmed by in vivo studies; optimal response at an AUC/MIC of 25; fungistatic effect maximal at 2-3× MIC; maximal effect constant over 8-24 h; PAFE observed in vivo	2, 36, 66
Flucytosine (5FC)	Candida spp.; C. neoformans	Concentration-independent fungistatic activity; PAFE, 2-4 h	Maximum fungistatic effect observed at concentrations ranging from 1-4× MIC; confirmed by in vivo studies; optimal response; when time above the MIC encompasses 25% of the dosing interval	2, 42a, 66