Different Doses of Micafungin for Prophylaxis of Invasive Fungal Diseases: A Web-based Non-Interventional Trial in Four Large University Hospitals in Germany

S. Heimann, O. A. Cornely, L. Meintker, W. Heinz, T. Schroeder, M. J. Vehreschild, H. Wisplinghoff, J. J. Vehreschild

Author address: 

Univ. Hosp. of Cologne, Cologne, GERMANY; UH of Erlangen, Erlangen, GERMANY; UH of Würzburg, Würzburg, GERMANY; UH of Düsseldorf, Düsseldorf, GERMANY

Abstract: 

Background: Treatment indications of new antifungals in clinical practice often deviate from the strict criteria used in controlled clinical trials. Under routine clinical conditions, beneficial and adverse effect not previously described in clinical trials may be observed. Aim of this study was to describe customary prescription and treatment strategies of micafungin (MIC). Methods: A registry was set up on www.ClinicalSurveys.net and physicians were invited to provide retrospective information on cases they had treated with MIC. Documentation comprised demographic information, underlying disease, efficacy, safety, and tolerability of MIC. Results: A total of 125 episodes of patients (PTS) hospitalized between 10/09 - 01/12 were documented, of which seven had to be excluded due to incomplete documentation. The most common underlying disease and risk factor of PTS was hematological malignancy (116, 98.3%) and antibiotic treatment > 3 days (115, 97.5%). Micafungin was administered as prophylaxis (PPX) in 106 (89.9%) and for treatment of possible, probable or proven IFD in 12 (10.1%) PTS. In the group of antifungal PPX, mean duration of MIC treatment was 22.8 days (d) (95% CI: 20.4 - 25.3); 53 of the PTS (50%) received a dosage of 50mg, while the other 53 (50%) received 100mg/d. For the different doses, prophylactic outcome was rated as success in 42 (79.2%) vs. 52 PTS (98.1%; p=0.002). Fifty-five PTS (51.9%) were treated with posaconazole (POS) before initiation of MIC, 30 PTS (28.3%) also received amphotericin b inhalation during PPX with MIC. Four PTS (3.8%) developed a proven IFD while being treated with 50mg/d MIC, compared to no PTS treated with 100mg/d. At the end of MIC PPX, 24 (22.6%) PTS were switched to fluconazole, 61 (66.1%) PTS to POS. Conclusions: Clinical effectiveness of MIC PPX in high risk PTS was demonstrated. In most cases, MIC was part of a multi-modal antifungal PPX strategy. Investigators reported better outcomes in PTS receiving therapeutic doses of MIC for PPX.
2013

abstract No: 

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Full conference title: 

53rd Interscience Conference on Antimicrobial Agents and Chemotherapy
    • ICAAC, 53rd (2013)