Table 2.

Pharmacokinetic/pharmacodynamic (PK/PD) indices and the magnitudes associated with antifungal clinical efficacy and toxicity

Antifungal class	PK/PD index	Pre-clinical PK/PD target for efficacy	Clinical PK/PD target for efficacy	Clinical PK/PD threshold for toxicity
Echinocandins	AUC0–24/MIC	fAUC0–24/MIC: 10–20	AUC0–24/MIC > 3000a	No data
Fluconazole	AUC0–24/MIC	AUC0–24/MIC: 25–44	AUC0–24/MIC ≥ 55–100	Unclear
Flucytosine	fT>MIC	≥ 20–45% fT>MIC	No data	Cmax > 100 mg/Lb
Isavuconazole	AUC0–24/MIC	fAUC0–24/MIC: 25–50	No data	No data
Itraconazole	AUC0–24/MIC	Cmax > 6 mg/Lc	Cmin ≥ 0.25–0.5 mg/L (Prop) Cmin ≥ 1 mg/L (Tx)	Cave ≥ 17.1 mg/Ld
Posaconazole	AUC0–24/MIC	fAUC0–24/MIC: 25–50	Cmin > 0.5 (Prop) Cmin > 1 mg/L (Tx)	No data
Voriconazole	AUC0–24/MIC	fAUC0–24/MIC: 25–50	Cmin ≥ 1–2 mg/L	Cmin ≥ 4.5–6 mg/Le

AUC_0–24/MIC = the ratio of the area under the concentration–time curve during a 24-h period to minimum inhibitory concentration; C_ave = average drug concentration; C_min = trough drug concentration; fAUC_0–24/MIC = the free (unbound drug concentration) ratio of the area under the concentration–time curve during a 24-hour period to minimum inhibitory concentration; fT_>MIC = the duration of time that the free drug concentration remains above the MIC during a dosing interval; PK/PD = pharmacokinetic/pharmacodynamic; Prop = prophylaxis; Tx = treatment

^aIn patients receiving micafungin for invasive candidiasis/candidemia

^bRelated to haematological toxicity and hepatotoxicity

^cConcentration determined by bioassay

^dMostly related to gastrointestinal toxicity

^eMostly related to hepatotoxicity and neurotoxicity