title: Efficacy of micafungin in empirical therapy of deep mycosis in surgically ill patients.
abstract: Micafungin (MCFG), an echinocandin antifungal agent, exhibits antifungal activity against Candida albicans and non-albicans Candida. The fungicidal activity of MCFG against clinical isolates of Candida species was investigated, and the clinical efficacy of MCFG in therapy of deep mycosis in surgery was studied using the AKOTT algorithm. The minimum inhibitory concentration and minimum fungicidal concentration values of fluconazole were ≤0.06-4 and >64 μg/ml, respectively, for each strain, whereas these values of MCFG were 0.008-0.5 and 0.016-1 μg/ml, suggesting that MCFG provided superior fungicidal ability against Candida albicans and non-albicans Candida. The subjects were separated into two groups: group A consisted of 20 subjects with both persisting fever refractory to broad-spectrum antibiotics and positive reaction to β-D-glucan test, and group B consisted of 20 subjects with either of those conditions. The overall response was evaluated as "effective" in 17 patients (85%) and 20 patients (100%) in groups A and B, respectively. In total, response was evaluated as "effective" in 37 patients (92.5%) and "ineffective" in 3 patients (7.5%). These findings suggest that MCFG administration should be used as empirical therapy for deep mycosis in surgically ill patients as it was shown to be an effective antifungal drug lacking serious adverse effects.
authors.affiliation: The Department of Surgery I, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan. k-okamot@med.uoeh-u.ac.jp
authors.forename: Kohji
authors.initials: K
authors.lastname: Okamoto
authors.forename: Takefumi
authors.initials: T
authors.lastname: Katsuki
authors.forename: Toshihisa
authors.initials: T
authors.lastname: Tamura
authors.forename: Shuichi
authors.initials: S
authors.lastname: Kanemitsu
authors.forename: Noritaka
authors.initials: N
authors.lastname: Minagawa
authors.forename: Takayuki
authors.initials: T
authors.lastname: Torigoe
authors.forename: Kazunori
authors.initials: K
authors.lastname: Shibao
authors.forename: Aiichirou
authors.initials: A
authors.lastname: Higure
authors.forename: Koji
authors.initials: K
authors.lastname: Yamaguchi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000494:pharmacology* / Q000627:therapeutic use; D002175:Candida / Q000187:drug effects*; D058365:Candidiasis, Invasive / Q000188:drug therapy / Q000382:microbiology*; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology; D004067:Digestive System Neoplasms / Q000382:microbiology / Q000601:surgery; D013505:Digestive System Surgical Procedures; D054714:Echinocandins / Q000494:pharmacology* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D055666:Lipopeptides / Q000494:pharmacology* / Q000627:therapeutic use; D008297:Male; D000077551:Micafungin; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000382:microbiology; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D000077551:Micafungin