JAC Advance Access published online on November 24, 2005
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dki410
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1 Medizinische Klinik und Poliklinik I, University of Bonn, Germany
* To whom correspondence should be addressed. Background: Caspofungin has shown efficacy in empirical antifungal therapy in neutropenic patients, refractory invasive Aspergillus infections and invasive candidiasis. Here we report the currently largest series of patients treated with caspofungin outside clinical trials. Methods: Centres in Germany that were known to treat patients with invasive fungal infections were asked to fill out detailed questionnaires for all patients treated with caspofungin. No effort was made to influence the decision to use caspofungin. Results: A total of 118 patients were evaluable (median age 48 years, interquartile range 38-58), out of which 41 (35%) suffered from acute leukaemia, 31 (26%) had allogeneic stem cell transplants, 16 (14%) lymphoma or myeloma, 8 (7%) autologous stem cell transplants and 22 (19%) other causes for immunosuppression. One hundred and six patients were evaluable for efficacy out of which 68 (64%) patients achieved a complete or partial remission. A total of 81 out of 115 (70%) patients were alive 30 days after the end of caspofungin therapy. Response rates were similar in proven (20/32, 63%) and probable (27/46, 59%) infections, in neutropenic patients (41/55, 75%) and in patients who were (44/70, 63%) or were not (24/36, 67%) refractory to antifungal pre-treatment. The response rate in mechanically ventilated patients was 29% (7/24). Caspofungin was well tolerated, even in 14 patients, who were concomitantly treated with ciclosporin A, no drug-related elevations of bilirubin, alanine aminotransferase or creatinine were found. Conclusions: This open case study of severely ill patients with invasive fungal infections demonstrates both excellent efficacy and very low toxicity of caspofungin.
Received May 18, 2005
Revised October 7, 2005
Accepted October 14, 2005
Original article
Caspofungin treatment in severely ill, immunocompromised patients: a case-documentation study of 118 patients
A. Glasmacher 1 *,
O. A. Cornely 2,
K. Orlopp 1,
S. Reuter 3,
S. Blaschke 4,
M. Eichel 5,
G. Silling 6,
B. Simons 7,
G. Egerer 8,
M. Siemann 9,
M. Florek 10,
R. Schnitzler 11,
P. Ebeling 12,
J. Ritter 13,
H. Reinel 14,
P. Schütt 12,
H. Fischer 15,
C. Hahn 1,
and
G. Just-Nuebling 5
2 Klinik I für Innere Medizin, University of Köln, Germany
3 Innere Medizin III, University of Ulm, Germany
4 Zentrum Innere Medizin, Abt. für Nephrologie und Rheumatologie, University of Göttingen, Germany
5 Medizinische Klinik und Poliklinik III, University of Frankfurt, Germany
6 Innere Medizin A--KMT-Zentrum, University of Münster, Germany
7 Klinik für Hämatologie, Onkologie und Klinische Immunologie, University of Düsseldorf, Germany
8 Med. Klinik und Poliklinik V, University of Heidelberg, Germany
9 Institut für Pathologie und Mikrobiologie, Städtisches Krankenhaus Kiel, Kiel, Germany
10 Med. Klinik und Poliklinik I, University of Dresden, Germany
11 Medizinische Klinik I, Krankenhaus Köln-Merheim, Germany
12 Innere Klinik und Poliklinik, University of Essen, Germany
13 Universitäts-Kinderklinik, University of Münster, Germany
14 Med. Klinik 5, Klinikum Nürnberg, Germany
15 Klinik für Allgemeine, Viszeral- und Transplantationschirurgie, University of Tübingen, Germany
A. Glasmacher, E-mail: glasmacher{at}uni-bonn.de
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