Micafungin versus caspofungin in the treatment of Candida glabrata infection: a case report.
BACKGROUND
Micafungin and caspofungin, which are both echinocandins, elicit their antifungal effects by suppressing the synthesis of β-D-glucan, an essential component of fungal cell walls. If micafungin is not effective against a fungal infection, is it unreasonable to switch to caspofungin?


METHODS
An 80-year-old Asian man presented to our hospital with brain and lung abscesses. Klebsiella pneumonia and Escherichia coli were identified by sputa culture and Streptococcus mitis was identified in the brain abscess culture obtained by drainage surgery. He was treated with antibiotics and both abscesses shrank after the treatment. But he continued to have a high fever and Candida glabrata was identified by blood culture. The origin of the infection was not clarified and micafungin was administered intravenously. The fungus showed poor susceptibility to micafungin; we then switched the antifungal from micafungin to caspofungin. After caspofungin treatment, his body temperature remained below 37 °C and his β-D-glucan levels decreased remarkably.


CONCLUSIONS
In vitro, micafungin is considered more effective against C. glabrata because its minimum inhibitory concentration against C. glabrata is lower than that of caspofungin. However, in vivo, there is no significantly different effect between the two drugs. When micafungin is not effective against candidiasis, a switch to caspofungin might be applicable because the pharmacokinetics in each echinocandin is slightly different.
Department of Neurosurgery, Teikyo University Mizonokuchi Hospital, 3-8-3 Mizonokuchi, Takatsu-ku, Kawasaki, Kanagawa, 213-8507, Japan. smyamada@med.teikyo-u.ac.jp.
Shoko Merrit
SM
Yamada
Department of Neurosurgery, Teikyo University Mizonokuchi Hospital, 3-8-3 Mizonokuchi, Takatsu-ku, Kawasaki, Kanagawa, 213-8507, Japan.
Yusuke
Y
Tomita
Department of Pharmacy, Teikyo University Mizonokuchi Hospital, 3-8-3 Mizonokuchi, Takatsu-ku, Kawasaki, Kanagawa, 213-8507, Japan.
Tomotsugu
T
Yamaguchi
Department of Pharmacy, Teikyo University Mizonokuchi Hospital, 3-8-3 Mizonokuchi, Takatsu-ku, Kawasaki, Kanagawa, 213-8507, Japan.
Toshiaki
T
Matsuki
D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use*; D001922:Brain Abscess / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology; D041221:Candida glabrata / Q000302:isolation & purification*; D002177:Candidiasis / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D000077336:Caspofungin; D054714:Echinocandins / Q000627:therapeutic use*; D005334:Fever / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D055666:Lipopeptides / Q000627:therapeutic use*; D008169:Lung Abscess / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology; D008297:Male; D000077551:Micafungin; D016896:Treatment Outcome
D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D000077336:Caspofungin; D000077551:Micafungin
Candidiasis; Case report; Caspofungin; Echinocandins; Fungal infection; Micafungin