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Achieving and maintaining therapeutic drug exposures with antifungals can be challenging in special patient populations, such as those with organ dysfunction (liver or kidney) or obesity, or elderly patients, due to dose-exposure relationships and potential drug-drug interactions. Dose adjustments may be needed in these populations to maintain therapeutic efficacy and/or prevent toxicity. We reviewed specific dosing considerations for antifungals in special populations with candidaemia and/or invasive candidiasis, focusing on those relating to echinocandins (based on prescribing information), and then explored the utility of the second-generation echinocandin rezafungin in treating these populations (based on currently available data identified from a PubMed and congress abstract search). Available data showed that echinocandins may sometimes require dosing modifications for special populations with candidaemia/invasive candidiasis, primarily due to decreases in pharmacokinetic exposures. Rezafungin appears to be suitable for use in a variety of special populations without the need for dose modifications based on available data, including patients with organ dysfunction or obesity, and elderly and critically ill patients. Further research is needed in populations where rezafungin data are not available including children, people living with HIV, patients receiving ECMO and those with underlying neurological conditions., Competing Interests: Declaration of Competing Interest The author is an Editorial Board Member/Editor-in-Chief/Associate Editor/Guest Editor for Journal of Infection and was not involved in the editorial review or the decision to publish this article. The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: OAC reports grants or contracts from Bundesministerium für Bildung und Forschung (BMBF), Cidara, Deutsches Zentrum für Infektionsforschung (DZIF), EU-Directorate-General for Research and Innovation (DG RTD), F2G, Gilead, Medpace, MSD, Mundipharma, Octapharma, Pfizer, Scynexis; Consulting fees from AbbVie, AiCuris, Basilea, Biocon, Boston Strategic Partners, Cidara, Seqirus, Gilead, GSK, IQVIA, Janssen, Matinas, Medpace, Menarini, Molecular Partners, MSGERC, Mundipharma, Noxxon, Octapharma, Pardes, Partner Therapeutics, Pfizer, PSI, Scynexis, Seres, Shionogi, The Prime Meridian Group; Speaker and lecture honoraria from Abbott, AbbVie, Akademie für Infektionsmedizin, Al-Jazeera Pharmaceuticals/Hikma, Amedes, AstraZeneca, Deutscher Ärzteverlag, Gilead, GSK, Grupo Biotoscana/United Medical/Knight, Ipsen Pharma, Medscape/WebMD, MedUpdate, MSD, Moderna, Mundipharma, Noscendo, Paul-Martini-Stiftung, Pfizer, Sandoz, Seqirus, Shionogi, streamedup!, Touch Independent, Vitis; Payment for expert testimony from Cidara; Participation on a Data Review Committee, Data and Safety Monitoring Board or Advisory Board for Cidara, IQVIA, Janssen, Medpace, PSI, Pulmocide, Vedanta Biosciences. HD received fees for national and international boards for Mundipharma®. MM received grants to her institution for Gilead; consulting fees or honoraria for lectures or manuscript writing from AlloVir, Gilead, Janssen, Moderna, Mundipharma, and Pfizer. RRR reports no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. CG-V received honoraria for talks on behalf of Gilead, MSD, Pfizer, Sanofi, Basilea, Shionogi, Mundipharma; and grant support from Gilead, Pfizer, GSK, MSD, PharmaMar. GRT is an Editorial Board Member/Editor-in-Chief/Associate Editor/Guest Editor for Journal of Infection and was not involved in the editorial review or the decision to publish this article. He is an Associate Editor for Journal of Infection and also reports grants and consulting fees from Amplyx, Astellas, Cidara, F2G, and Manye; grants from Merck; and data safety monitoring board membership for Pfizer. MH received research funding and honoraria from Gilead, Astellas, MSD, IMMY, Pulmocide, Shionogi, Melinta, Mundipharma, Scynexis, F2G, Pfizer – outside of the submitted work., (Copyright © 2025 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

We evaluated the in vitro activity of olorofim against Coccidioides species. Olorofim demonstrated potent in vitro activity against all isolates tested with a minimum inhibitory concentration (MIC) range ≤0.008-0.06 µg/mL and geometric mean MIC of 0.010 µg/mL. This activity was also maintained against isolates with elevated fluconazole MICs (≥16 µg/mL), including strains with MICs ≥32 µg/mL (olorofim MIC range ≤0.008-0.06 µg/mL and geometric mean MICs of ≤0.009 and ≤0.013 µg/mL, respectively)., Competing Interests: This study and olorofim powder were provided by F2G, Ltd. N.P.W. has received research support to the UT Health San Antonio from bioMerieux, F2G, Mycovia, Sfunga, and Scynexis and has served on an advisory board for F2G. G.R.T. has served as a consultant and received research support from Astellas, Amplyx, Cidara, F2G, Mayne, Melinta, Mundipharma, Scynexis, and the DSMB for Pfizer. T.F.P. has served as a consultant and/or received research support from Cidara, F2G, Gilead, Scynexis, and Elion Therapeutics.

Infusion reactions (tachycardia, hypertension, fever, etc.) associated with liposomal amphotericin B are common. Animal models have found complement activation responsible, yet the pathophysiology has not been evaluated in human patients. We performed a prospective observational study and found complement activation-related pseudoallergy (CARPA) responsible in those with infusion reactions.

Background: Patients with pulmonary coccidioidomycosis often experience prolonged symptoms lasting weeks to months. Limited data exist regarding whether fluconazole prevents development of disseminated disease or shortens symptom duration. We describe factors associated with fluconazole receipt and assess its effect on outcomes among patients with pulmonary coccidioidomycosis., Methods: Using the MerativeTM MarketScan® Commercial Database, we identified immunocompetent patients ages 18-64 with incident pulmonary coccidioidomycosis during 2017-2023 and continuous enrollment in the 180 days before and after diagnosis. We examined demographic and clinical differences between patients treated vs. not treated with fluconazole and performed 1:1 greedy nearest neighbor propensity score matching to control for these differences. We performed bivariate analyses on the matched subset to evaluate patient outcomes by fluconazole receipt., Results: Among 1,448 patients with pulmonary coccidioidomycosis, 659 (46%) received fluconazole. Patients who received fluconazole more frequently had pre-diagnosis symptoms (95% vs. 72%, p<0.001) and antibiotic prescriptions (68% vs. 32%, p<0.001) than those who did not. Among the propensity score matched subset (n=696), hospitalization (4% vs. 1%, p=0.004) and disseminated coccidioidomycosis (3% vs. 0%, p=0.006) were more frequent among patients who received fluconazole. The median number of days from diagnosis to last visit for chest pain (50.0 vs. 46.5), cough (64.0 vs. 39.0), fatigue (63.0 vs. 65.5), myalgia (98.0 vs. 74.0), and joint pain (93.5 vs. 107.5) was not significantly different between treatment groups., Conclusions: Our results support existing guidelines that fluconazole may not be associated with improved outcomes for certain immunocompetent patients with pulmonary coccidioidomycosis., (Published by Oxford University Press on behalf of Infectious Diseases Society of America 2025.)