Non-comparative study of caspofungin for treatment of fungal infections

T. Lejko-Zupanc,1 S. Zver,2 A. Špec-Marn,3 J. Tomažic ,1 V. Papuga,4 M. Jereb,1 B. Šibanc,5 B. Ožek,6 Z. Novak7 and

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1Clinical Centre Ljubljana, Infectious Diseases Clinic, Ljubljana, Slovenija, 2Haematology Department, Clinical Centre Ljubljana, Ljubljana, Slovenija, 3Department for Anesteziology and Intensive Care Medicine, Clinical Centre Ljubljana, Ljubljana,


Objective: To evaluate the efficacy and tolerability of caspofungin for the treatment of presumed or proven fungal infections in everyday practice. Study design: Prospective non-comparative study conducted in University Medical Centre and in three general hospitals in Slovenia in 2004. Patients who received caspofungin were included. Demographic data, data on concomitant diseases, previous antifungal therapy, fungal pathogen, caspofungin dosage and treatment outcome were collected. Results: A total of 50 patients (33 male, 17 female; mean age 57.3 years; age range 1984 years) were included in the study. Underlying diseases were: haematological malignancy in 14 patients, treatment in medical/surgical ICU for various serious conditions in 18 patients, polytrauma in four patients, other immunocompromised states in seven patients, various serious medical diseases, requiring long-term antibiotic treatment in seven patients. In majority of the patients caspofungin was used as 70 mg loading dose and 50 mg day-1 thereafter. The average duration of treatment was 19.2 days (3 85 days). Antifungal treatment was empirical in 10 patients. Fungal infection was presumed in 16 patients and proven in 24 patients. Various Candida species (albicans in nine patients, non-albicans in 19 patients) were isolated in 28 patients (56%) and Aspergillus spp. in 10 (20%) patients. In two patients, infection as the result of Pneumocystis carinii was proven. Both of the patients were cured. Thirty-six (72%) patients have previously received other antifungal treatment. Thirteen patients (26%) died, six of them due to fungal infections. In seven patients, the death occurred in the first week of treatment. Overall the clinical success was observed in 32 (64%) patients. Overall success rate in Candida infections was 71%. More than 50% of Candida species were resistant or less susceptible to fluconazole. Clinical success rate in fluconazole-resistant group was 87%. Of the 10 patients with Aspergillus infection five died, three of them due to fungal infections (failure in 30%), clinical success was documented in 3/10 (30%). In the group of patients with empirical antifungal therapy improvement was noted in 7/10 patients. The tolerability of caspofungin was estimated as good or very good in 90% of the patients. Only in two (4%) patients the treatment was discontinued due to adverse event. Conclusion: Our mixed population of patients represents the everyday clinical situation. Overall success rate of caspofungin in this setting was 64% and in patients who received caspofungin for 7 days was 76%. The most notable clinical success was in the group of patients with C. glabrata and C. krusei infections. The success rate was lower in patients with invasive aspergillosis, probably due to late diagnosis and poor clinical condition of the patients. Caspofungin was well tolerated in various clinical settings in patients with serious underlying medical or surgical conditions.

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2nd Trends in Medical Mycology
    • TIMM 2nd (2010)