Relationship between the initial dose of micafungin and its efficacy in patients with candidemia.
Micafungin, the first licensed echinocandin in Japan, has shown excellent in vitro and in vivo activity against all Candida species. However, the appropriate dose for the initial treatment of candidemia remains to be determined. In this study, we retrospectively examined the relationship between the clinical outcome of candidemia and the initial dose of micafungin. Patients were divided into two groups according to the initial dose of micafungin administered: group I (<2.25 mg/kg/day) and group II (>or=2.25 mg/kg/day). Micafungin produced an excellent 30-day clinical response in patients with candidemia, including Candida parapsilosis; the overall 30-day clinical response was 86%. The administration of higher doses of micafungin accelerated the clinical response and duration until the clinical response in group II was significantly shorter than that in group I (P = 0.021). However, no significant differences were observed in the 30-day mortality attributable to the fungal infection between the two groups. Considering these results, we recommend the administration of 2.25 mg/kg/day or more of micafungin in the initial treatment of patients with candidemia.
Ota
Yasuo
Y
Department of Infectious Diseases, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Tokyo 113-8655, Japan. yasuota-tky@umin.ac.jp
Tatsuno
Keita
K
Okugawa
Shu
S
Yanagimoto
Shintaro
S
Kitazawa
Takatoshi
T
Fukushima
Atsuhito
A
Tsukada
Kunihisa
K
Koike
Kazuhiko
K
D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000008:administration & dosage*; D002177:Candidiasis / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D054714:Echinocandins / Q000008:administration & dosage*; D005260:Female; D016469:Fungemia / Q000188:drug therapy*; D006801:Humans; D055666:Lipopeptides; D008074:Lipoproteins / Q000008:administration & dosage*; D008297:Male; D000077551:Micafungin; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis
D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D008074:Lipoproteins; D000077551:Micafungin