Caspofungin for the treatment of less common forms of invasive candidiasis

Oliver A. Cornely, Martin Lasso, Robert Betts, Nickolay Klimko, Jose Vazquez, Geoff Dobb, Juan Velez, Angela Williams-Diaz, Joy Lipka, Arlene Taylor, Carole Sable, Nicholas Kartsonis

Research output: Contribution to journalArticle

109 Scopus citations

Abstract

Objectives: Caspofungin has demonstrated efficacy in invasive candidiasis. However, in a comparative study, most patients (>83%) had candidaemia. Therefore, we performed a study in patients with non-fungaemic invasive candidiasis. Patients and methods: Adults with proven non-fungaemic invasive candidiasis or probable chronic disseminated candidiasis (CDC) received caspofungin primary or salvage monotherapy. Most patients received 50 mg daily following a 70 mg loading dose. Patients with endocarditis, osteomyelitis or septic arthritis received caspofungin at 100 mg daily and were allowed dose escalation up to 150 mg. Primary efficacy endpoint was the overall response at end of caspofungin therapy. A favourable overall response required complete resolution of symptoms and either eradication of Candida or radiographic resolution. Results: All 48 patients enrolled had confirmed infection and received ≥ 1 dose of caspofungin. At study entry, 8% were neutropenic. The mean APACHE II score was 14.3. Most infections were due to Candida albicans (60%) or Candida glabrata (14%). The overall success at end of caspofungin therapy was 81. Success by site of infection was as follows: peritonitis 77% (10/13), abdominal abscess 89% (8/9), CDC 88% (7/8), osteomyelitis/septic arthritis 100% (4/4), endocarditis 33% (1/3) and multiple sites 75% (6/8). Outcomes were similar across Candida spp. None of the patients had a serious drug-related adverse event or discontinued caspofungin due to toxicity. Overall mortality until 12 week follow-up was 23%. Conclusions: In deep-seated invasive candidiasis, including peritonitis, abdominal abscesses, CDC and arthritis, caspofungin was effective and safe at regular doses and up to 100 mg daily.

Original languageEnglish (US)
Pages (from-to)363-369
Number of pages7
JournalJournal of Antimicrobial Chemotherapy
Volume60
Issue number2
DOIs
StatePublished - Aug 2007
Externally publishedYes

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Keywords

  • Abdominal abscess
  • Candida
  • Chronic disseminated candidiasisArthritis
  • Endophthalmitis
  • Peritonitis

ASJC Scopus subject areas

  • Pharmacology
  • Microbiology (medical)
  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Cornely, O. A., Lasso, M., Betts, R., Klimko, N., Vazquez, J., Dobb, G., Velez, J., Williams-Diaz, A., Lipka, J., Taylor, A., Sable, C., & Kartsonis, N. (2007). Caspofungin for the treatment of less common forms of invasive candidiasis. Journal of Antimicrobial Chemotherapy, 60(2), 363-369. https://doi.org/10.1093/jac/dkm169