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JAC Advance Access originally published online on May 26, 2007
Journal of Antimicrobial Chemotherapy 2007 60(2):363-369; doi:10.1093/jac/dkm169
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© The Author 2007. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Caspofungin for the treatment of less common forms of invasive candidiasis

Oliver A. Cornely1,*, Martin Lasso2, Robert Betts3, Nickolay Klimko4, Jose Vazquez5, Geoff Dobb6, Juan Velez7, Angela Williams-Diaz8, Joy Lipka8, Arlene Taylor8, Carole Sable8 and Nicholas Kartsonis8

1 Klinik I für Innere Medizin, Klinikum der Universität zu Köln, 50924 Köln, Germany 2 Hosp Sotero del Rio, Av. Concha y Toro 3459, Puenta Alto, Santiago, Chile 3 University Rochester Medical Center, Box 689, Rochester, NY 14642, USA 4 Medical Academy Postgraduate Education, Santiago de Cuba St., 1/28, St Petersburg, Russia 5 Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA 6 Royal Perth Hospital, GPO Box X2213, Perth 6001, Western Australia, Australia 7 Fundacion Valle del Lili, Cra 98 #18-49, Cali, Colombia 8 Merck Research Laboratories, 10 Sentry Parkway, Blue Bell, West Point, PA 19486, USA

Received 11 February 2007; returned 21 March 2007; revised 13 April 2007; accepted 20 April 2007

* Corresponding author. Tel: +49-221-478-6494; Fax: +49-221-478-3611; E-mail: oliver.cornely{at}ctuc.de or oliver.cornely{at}uni-koeln.de

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.

Keywords: Candida peritonitis , abdominal abscess , chronic disseminated candidiasis , arthritis , endophthalmitis


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