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Caspofungin dosing obese patients – Plasma concentrations of caspofungin in a critically ill patient with morbid obesity

The results of the logistic regression models using BMI as a continuous variable support the results of Fisher's exact test using BMI as a categorical variable. Federal Government.

Lucas Cox
Sunday, July 28, 2019
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  • An additional contributing factor to the excess mortality associated with these infections in this age group is the increased resistance profile of the pathogens involved, due to different strain prevalence and previous exposure to antifungals.

  • Baseline patient demographics and caspofungin duration by indication and BMI category. Obesity Fungal Infection.

  • All other authors declare no conflicts of interest.

  • View Metrics.

  • Candidemia has been found to represent a significant proportion of catheter- and non-catheter- related bloodstream infections and to be the most common IFD in the ICU 56. Antifungal susceptibility of clinical Cryptococcus gattii isolates from Colombia varies among molecular types.

Invasive fungal infections in the critically ill pediatric and adult patient

Although the number of morbidly obese patients was low, no comparable differences were caspoffungin when evaluating the outcomes of morbidly obese patients, thereby further supporting the overall lack of association for caspofungin between high BMI and lower efficacy. Efficacy outcomes favorable outcomes were pre-specified in each of the specific study protocols [ 4—12 ]. Payne and Hall [ 4 ] found that lower caspofungin AUC was achieved in obese people than in thinner ones, suggesting that dose optimization in heavier patients might improve clinical success rates. Warning You have reached the maximum number of saved studies

Pharmacokinetics, safety, and tolerability of caspofungin in children and adolescents. Moreover, physicians are usually more hesitant to apply sosing diagnostic procedures such as bronchoscopy or organ biopsies to patients in this age group. For patients with severe hepatic insufficiency there are no data for the use of micafungin, and it should be avoided. Overall, these data support the hypothesis that there is no significant difference in efficacy outcomes for caspofungin when comparing obese to non-obese patients with invasive candidiasis or patients receiving empirical therapy for suspected invasive fungal infections in the setting of persistent fever and neutropenia.

Two PK studies in healthy subjects suggest a patirnts in serum trough concentrations C 24 in higher weight individuals [ 1415 ]. Ryan, Robert J. February 4, Key Record Dates. The aim of the study was to describe the pharmacokinetic behaviour of caspofungin in a critically ill patient with morbid obesity who received doses of caspofungin higher than labelled doses. Three days later, Cpeak was 5.

Caspofungin pharmacokinetic PK data in higher weight individuals is limited. The effects of caspofungin on pregnancy are unknown. For each condition, the median duration of standard caspofungin therapy was similar in the majority of BMI category groups. About this article.

Abbreviations

Open in new tab. In most of the cases serum concentrations of antifungals may be subtherapeutic especially in the hypermetabolic phase of thermal injury. Numerous interactions with other drugs, which are CYP3A4 substrates, have been observed and complicate itraconazole treatment

Listing a study does not mean caspofungin dosing obese patients has been evaluated by the U. Latest Most Read Most Cited Molecular epidemiology of aspergillosis in Magellanic penguins and susceptibility patterns of clinical isolates. The most common clinical and laboratory drug-related AEs were also reviewed. Sign In or Create an Account. Inclusion Criteria: Male and female subjects, age 18 years of age or older, of all racial and ethnic origins. Advanced Search. Patients who discontinued treatment before documented improvement were considered treatment failures regardless of reason for discontinuation.

Initial data do not suggest however severely affected drug metabolism and levels. The aim of the study was to describe the pharmacokinetic behaviour of caspofungin caspofkngin a critically ill patient with morbid obesity who received doses of caspofungin higher than labelled doses. View 3 excerpts, references background. As epidemiology of candidemia in critically ill patients is changing with the proportion of non-albicans Candida species especially fluconazole-resistant strains rising 74echinocandins are administered as first line antifungal treatment in critically ill cirrhotic patients Safety and efficacy outcomes were retrospectively compared for obese versus non-obese patients who received standard caspofungin doses for different clinical conditions in nine clinical trials within the Merck caspofungin database.

Introduction

Availability of data and materials All relevant data are within the paper. Over the last caspofunngin years, a sufficiently large number of obese patients have enrolled into Merck-sponsored caspofungin clinical trials to allow for this retrospective comparison of efficacy outcomes and safety data between obese and non-obese adult patients. Sign In. Interestingly, these results suggest that empirical therapy patients with high BMIs generally respond to treatment more often than patients with a low BMI.

Micafungin is the only echinocandin that has been approved for use in neonates doding Europe We… Expand. The dose of caspofungin should be adjusted according to both serum caspofungin concentrations and clinical symptoms. A major strength of this analysis is that all patients received a standard dose of caspofungin monotherapy 50 mg daily, with or without a mg loading dose on Day 1. Another study suggested anidulafungin clearance increased with increasing body weight [ 18 ]. Limited PD data from clinical studies of echinocandins in patients with invasive candidiasis are in agreement with those derived from animal models

Open in new tab Download slide. Keywords: Antifungal; antimetabolite; azole; echinocandin; effectiveness; obesity; pharmacokinetics; polyene; safety; weight. Obese patients : 02 August Caspofungin patienfs IV each volunteer will only receive one dose of the study drug. Payne and Hall [ 4 ] found that lower caspofungin AUC was achieved in obese people than in thinner ones, suggesting that dose optimization in heavier patients might improve clinical success rates. After administration of the first dose, Cpeak was 4. A small number of patients 9 in the invasive candidiasis group and 15 in the empirical therapy group were considered morbidly obese Table 3.

Introduction

Due to the small number of obese patients with invasive aspergillosis or esophageal candidiasis, obese patients could not be directly compared with non-obese patients. Last Update Posted : February 10, Table 3 Proportion of patients with favorable efficacy outcomes by indication and BMI category.

Liver toxicity is observed frequently with their use; however, hepatic failure is uncommon Studies on patients with invasive aspergillosis treated with azoles have mostly focused on the relationship of trough concentrations with outcome. Google Scholar. Has PDF. Most of the available data on antifungal PK parameters in patients with thermal injury are for fluconazole ,

It is extensively metabolized in the liver, mostly by CYP3A4 enzyme. Candidemia and intra-abdominal Candida infections represent the largest proportion of IFD Candida infections 2. Dose finding in aspergillosis. Int J Antimicrob Agents.

References

In addition, as doisng in the empirical therapy study was based on a composite endpoint of five individual components, the efficacy of each individual component was also found to be generally similar across BMI categories. Advanced Search. Adverse experiences AEs were collected during the caspofungin therapy period and for 14 days thereafter. Email alerts Article activity alert.

Dosin, questions have arisen regarding use of weight as a factor in determining caspofungin dosing for obese adults. However, weight caspofungin dosing obese patients height are critical factors in determining caspofungin dosing for pediatric patients [ 3 ], and patient weight is a factor in determining dosing for some other antifungal agents e. Outcome Measures. Read our disclaimer for details. Caspofungin pharmacokinetic PK data in higher weight individuals is limited. Last Update Posted : February 10, Sign In.

Three days later, Cpeak was 5. Within each indication, Fisher's exact test was performed to assess whether BMI is associated vosing response to treatment with caspofungin. Safety was evaluated based on drug-related AEs in accordance with the site investigator determination that they were definitely, probably, or possibly related to caspofungin therapy. Search all BMC articles Search. National Institutes of Health U. More studies are needed to determine if and when dosing changes are needed for many of the antifungal agents. Nicholas A.

  • Patients who discontinued treatment before documented improvement were considered treatment failures regardless of reason for discontinuation.

  • As patient demographics shift and more overweight and obese patients are treated with caspofungin, additional information is needed regarding proper caspofungin dosing for the adult patient population. Dose finding in aspergillosis.

  • View 1 excerpt, cites background.

  • Reprints and Permissions. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below.

  • References 1. Dosing of antifungal agents in obese people.

Correspondence to Rafael Ferriols-Lisart. In an ex vivo study using different ECMO circuits, micafungin was found to be extracted by the circuit whereas fluconazole was not Fluconazole is in vitro active against most Candida species that are frequently isolated from neonates C. Download citation.

PJ participated in study conception, gut hormones in obesity therapeutic strategies of data and helped to draft the manuscript. You can also search for this author in PubMed Google Scholar. A multicenter, double-blind trial of a high-dose caspofungin treatment regimen versus a standard caspofungin treatment regimen for adult patients with invasive candidiasis. Crit Care 21, For general information, Learn About Clinical Studies. With regard to safety, the AE profile for caspofungin seems generally consistent between BMI categories across and within a specific indication.

Abbreviations

Published online Dec Candidemia and intra-abdominal Candida infections represent the largest proportion of IFD Candida infections 2. Influence of echinocandin administration on hemodynamic parameters in medical intensive care unit patients: a single center prospective study.

Concomitant use of rifamycins, tacrolimus, or cyclosporine. More Information. For illnesses with high morbidity or mortality such as invasive fungal infectionsit is critical that clinicians are confident that all patients are receiving the appropriate, therapeutic dose of a well-tolerated medication. Actual Enrollment :. Open in new tab.

For invasive candidiasis echinocandins are first-line agents and caspofungin is the most frequently used antifungal agent. Metrics details. Echinocandins are used in the empiric treatment of invasive candidiasis and aspergillosis in critically ill, neutropenic, and transplant patients. More data are needed for patients with thermal injury to optimize antifungal dosing. Sign In or Create an Account. Overall, these data support the hypothesis that there is no significant difference in efficacy outcomes for caspofungin when comparing obese to non-obese patients with invasive candidiasis or patients receiving empirical therapy for suspected invasive fungal infections in the setting of persistent fever and neutropenia. Another study suggested anidulafungin clearance increased with increasing body weight [ 18 ].

  • In a multicenter European cohort study of critically ill patients the PK parameters of patients receiving fluconazole, anidulafungin and caspofungin were analyzed Defining Antibiotic Levels in Intensive care, DALI study Baseline patient demographics and caspofungin duration by indication and BMI category.

  • Caspofungin pharmacokinetic PK data in higher weight individuals is limited.

  • This practically means that drug caspofungin dosing obese patients near the MIC for a hour period would likely achieve this target An additional contributing factor to the excess mortality associated with these infections in this age group is the increased resistance profile of the pathogens involved, due to different strain prevalence and previous exposure to antifungals.

Issue Section:. In addition, as efficacy in the empirical therapy study was based on a composite endpoint of five individual components, the efficacy of each individual component was also found caspofungin dosing obese patients be generally similar across BMI categories. Efficacy outcomes favorable outcomes were pre-specified in each of the specific study protocols [ 4—12 ]. You can also search for this author in PubMed Google Scholar. Keywords: Antifungal; antimetabolite; azole; echinocandin; effectiveness; obesity; pharmacokinetics; polyene; safety; weight. Patients included in the efficacy analysis had to meet the definition of disease at baseline i. Warning You have reached the maximum number of saved studies

Caspofungin: pharmacodynamics, pharmacokinetics, clinical uses and treatment outcomes. The efficacy analysis in patients with invasive aspergillosis or esophageal candidiasis was limited due to the small number of obese patients. In general, lipid formulations of amphotericin B do not need dose adjustment, nevertheless the probability of nephrotoxicity must be taken into account; flucytosine and fluconazole should be administered according to creatinine clearance and echinocandins do not require adjustment. About this article. For Candida isolates with higher MICs, which may be frequent according to local epidemiology, higher daily doses are recommended, as mentioned previously In most of the cases serum concentrations of antifungals may be subtherapeutic especially in the hypermetabolic phase of thermal injury. Patients with C.

Publication types

A small number of patients 9 in the invasive candidiasis group and 15 in the empirical therapy group were considered morbidly obese Table 3. Novel preventative strategies against invasive aspergillosis. Email alerts Article activity alert.

The dose of caspofungin should be adjusted according to both serum caspofungin concentrations acspofungin clinical symptoms. Department of Health and Human Services. Published : 02 August Crit Rev Microbiol. Overall, these data support the hypothesis that there is no significant difference in efficacy outcomes for caspofungin when comparing obese to non-obese patients with invasive candidiasis or patients receiving empirical therapy for suspected invasive fungal infections in the setting of persistent fever and neutropenia.

ALSO READ: Chronic Disease Related To Obesity In Children

Candidiasis in neonates with extremely low birth weight ELBW is frequent, is associated with high morbidity and may be followed by hematogenous Candida meningoencephalitis HCME found almost exclusively in this age capofungin All echinocandins are metabolized in the liver via pathways other than the CYP enzyme system This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Currently available evidence does not support the routine use of therapeutic drug monitoring TDM for this class of antifungal agents Caspofungin pharmacokinetic PK data in higher weight individuals is limited.

View Metrics. Caspofungin pharmacokinetic PK data in higher weight individuals is limited. A major strength of this analysis is that all patients received a standard dose of caspofungin monotherapy 50 mg daily, with or without a mg loading dose on Day 1. Caspofungin versus liposomal amphotericin B for empirical antifungal therapy in patients with persistent fever and neutropenia. As such, it is not known if other factors may have influenced outcome, such as severity of underlying disease sconcomitant disease, or neutropenic status, were evenly distributed amongst the patients within BMI categories.

Dosing of antifungal agents in obese people. Echinocandin Obesity Pharmacokinetics Pharmacodynamics Fungal infection. Due to the small number of obese patients with invasive aspergillosis or esophageal candidiasis, obese patients could not be directly compared with non-obese patients. Eligibility Criteria. Published : 02 August Volume

Publication types

Caspofungin versus liposomal amphotericin B for empirical antifungal therapy caspofungin dosing obese patients patients with persistent fever and neutropenia. Nicholas ;atients. Correspondence: Nicholas A. For many pharmacologic agents, there is limited, inconclusive, or an absence of clinical data specifically involving the use of individual therapies in obese patients. In groups in which the proportion of obese patients was small, a comparison of underweight and normal versus overweight and obese patients was performed.

A randomized double-blind study of caspofungin versus fluconazole for the treatment of esophageal candidiasis. Randomized, double-blind, obrse study of caspofungin versus amphotericin Obese patients for treatment of oropharyngeal and esophageal candidiasis. A small number of patients 9 in the invasive candidiasis group and 15 in the empirical therapy group were considered morbidly obese Table 3. Candidemia and intra-abdominal Candida infections represent the largest proportion of IFD Candida infections 2. Fisher's exact test was performed to determine if there was a signal of a potential efficacy difference between BMI categories within a particular indication.

For illnesses with high morbidity or mortality such as invasive fungal infectionsit is critical that clinicians are confident that all patients are receiving the appropriate, therapeutic dose of a well-tolerated medication. Open in new tab. Study Start Date :. In addition, given the biases in selecting patients for clinical trials, it is not known if the patients in this analysis appropriately reflect the population as a whole.

Antifungal agents: pharmacokinetic, pharmacodynamic and dosage considerations

Similarly, an adult patient patients was on ECMO and received voriconazole, caspofungin and amphotericin B was found to have low or even undetectable concentrations obfse both caspofungin and voriconazole In children caspofungin and micafungin have been approved for primary targeted therapy of invasive candidiasis in Europe With regard to the echinocandins, no particular interactions with other drugs are of clinical significance, with the exception of immunosuppressants, such as cyclosporine or tacrolimus, which may require increase of the administered dose. Although the number of patients with caspofungin and anidulafungin was limited, in general antifungal exposure was found to be lower than healthy volunteers 46-

  • AEs related to caspofungin occurred in similar proportions with non-obese and obese patients across all and within the four clinical conditions.

  • Materials and methods.

  • For the treatment of HCME in neonates, both DAMB and lipid formulations have shown similar efficacy based on few clinical studies as well as some preclinical models 86 ,

  • Finally, the proportions of patients with individual clinical or laboratory drug-related AE terms were generally similar across BMI categories data not shownand no trends were identified with increasing or decreasing weight. Publication types Review.

For Candida isolates with higher MICs, which may be frequent according to local epidemiology, higher daily doses are recommended, as mentioned pagients Higher doses, or even more frequently administered are suggested for children aged less than 2 years of age, but there are limited safety data Pediatric data for the use of anidulafungin have just been published Similarly, an adult patient who was on ECMO and received voriconazole, caspofungin and amphotericin B was found to have low or even undetectable concentrations of both caspofungin and voriconazole As epidemiology of candidemia in critically ill patients is changing with the proportion of non-albicans Candida species especially fluconazole-resistant strains rising 74echinocandins are administered as first line antifungal treatment in critically ill cirrhotic patients Try out PMC Labs and tell us what you think.

  • Absorption is improved with fatty meals.

  • Epub Mar 4. Download all slides.

  • Published online Dec

  • Analyses were predominantly based on the four categorical BMI groups indicated above. Among the three currently available members of echinocandin family, caspofungin is the one that warrants dose reduction in patients with severe liver impairment as the drug molecule becomes transformed in the liver and the recommended dose is 35 mg daily.

  • Nicholas A.

  • The monitoring of hemodynamic parameters in these patients is highly recommended. All authors read and approved the final manuscript.

The results gut hormones in obesity therapeutic strategies the logistic regression models using BMI as a continuous variable support the results of Fisher's exact test using BMI as a categorical variable. For the treatment of HCME in neonates, both DAMB and lipid formulations have shown similar efficacy based on few clinical studies as well as some preclinical models 86 It is mainly excreted unchanged in the feces and only partially metabolized to multiple glucuronide conjugates. Availability of data and materials All relevant data are within the paper. An additional contributing factor to the excess mortality associated with these infections in this age group is the increased resistance profile of the pathogens involved, due to different strain prevalence and previous exposure to antifungals. Given the inherent limitations of this type of analysis, firm conclusions about the influence of obesity on safety and efficacy outcomes of standard dosing of caspofungin therapy cannot be drawn. Limited PD data from clinical studies of echinocandins in patients with invasive candidiasis are in agreement with those derived from animal models

Optimal doses of caspofungin during continuous venovenous hemodiafiltration in critically ill patients. Dosing Antifungals in Obesity: a Literature Review. Thus, in this age group and especially for ELBW neonates, antifungal fluconazole prophylaxis is justified as part of the antifungal prevention strategy. Alobaid et al.

Another study suggested anidulafungin clearance increased with increasing body weight [ 18 ]. Actual Study Completion Date :. AEs related to caspofungin occurred in similar proportions with non-obese and obese patients across all and within the four clinical conditions.

  • All relevant data are within the paper.

  • Study Type :.

  • View author publications.

  • Baseline characteristics gender, age, and race and duration of study therapy data are also displayed to ensure comparability amongst the different BMI categories.

  • Dosing Antifungals in Obesity: a Literature Review.

FLR conceived the study, participated in designing and coordinating the study and drafted the manuscript. Within each indication, Fisher's exact test was performed to assess whether BMI is associated with response to treatment with caspofungin. Search for terms. Email alerts Article activity alert. A randomized double-blind study of caspofungin versus amphotericin for the treatment of candidal esophagitis.

Citing articles via Web of Science 8. Permissions Icon Permissions. Correspondence to Rafael Ferriols-Lisart. About this article. All authors read and approved the final manuscript. Related articles in Web of Science Google Scholar. The effects of caspofungin on pregnancy are unknown.

References

You can also search for this author in PubMed Google Scholar. However, weight and height are critical factors in determining caspofungin dosing for pediatric patients [ 3 ], and patient weight is a factor in determining dosing for some other antifungal agents e. Obesity Fungal Infection.

Actual Study Completion Date :. Download references. In addition, given the biases in selecting patients for clinical trials, it is not known if the patients in this analysis appropriately reflect the population as a whole. In most circumstances, echinocandins have fixed dosing recommendations for adults. Patients whose BMI was not calculable at study entry e. Citing articles via Web of Science 8. More Information.

Exclusion Criteria: Pregnant or nursing or unwilling to use a reliable contraception method during the study. Receive exclusive offers and updates from Oxford Academic. Dosing of antifungal agents in obese people. Suspected or documented systemic fungal infection.

Influence of echinocandin administration on hemodynamic parameters in medical intensive care unit obese patients a single center prospective study. Patients with thermal injury have significant pathophysiological disturbances that may affect PK and PD parameters of antifungal agents Citing articles via Web of Science 8. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Oxford Academic. Article Navigation.

The patient was in septic shock, with Candida multicolonization and other risk factors of invasive candidiasis. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Keywords: Antifungal; antimetabolite; azole; echinocandin; effectiveness; obesity; pharmacokinetics; polyene; safety; weight. Antifungal susceptibility of clinical Cryptococcus gattii isolates from Colombia varies among molecular types. Within each indication, Fisher's exact test was performed to assess whether BMI is associated with response to treatment with caspofungin.

As this was a retrospective post-hoc patisnts, formal statistical analysis testing of a pre-specified hypothesis with associated power statements was not performed. This retrospective post-hoc evaluation of caspofungin dosing obese patients nine studies was performed to compare safety and efficacy for obese versus non-obese patients using BMI categories. Echinocandins are excreted to a comparatively very low amount as unchanged drug in the urine; despite anecdotal reports of successful treatment of Candida urinary tract infections they are not considered treatment of choice. It is extensively metabolized in the liver, mostly by CYP3A4 enzyme. Email alerts Article activity alert. Their activity against Candida biofilms, which rapidly form on the surface of foreign devices, such as central venous catheters has been established Sign In or Create an Account.

Eligibility Criteria. Caspofungkn Primary Completion Date :. Download references. AEs related to caspofungin occurred in similar proportions with non-obese and obese obesity therapeutic strategies across all and within the four clinical conditions. Study oversight, data collection and processing, and analysis for each clinical trial were done by Merck Research Laboratories. More studies are needed to determine if and when dosing changes are needed for many of the antifungal agents.

EGC participated in analyzing serum data and helped to draft the manuscript. Randomized, double-blind, multicenter study of caspofungin versus amphotericin B for treatment of oropharyngeal and esophageal candidiasis. COVID vaccine hesitancy in adults with multiple sclerosis in the United States: A follow up survey during the initial vaccine rollout in Dose finding in aspergillosis. Due to the small number of obese patients with invasive aspergillosis or esophageal candidiasis, obese patients could not be directly compared with non-obese patients.

Another study suggested anidulafungin clearance increased with increasing body weight [ 18 ]. Caspofungin: pharmacodynamics, pharmacokinetics, clinical uses and treatment outcomes. Advanced Search. More Filters.

  • The use of caspofungin in neonates is based on very limited data 95 ,

  • Table 4 Summary of safety by BMI category.

  • By having this knowledge they can adjust the regimens of the antifungal agents as well as those of other agents to achieve the best outcome of the critically ill patients.

  • Safety was evaluated based on drug-related AEs in accordance with the site investigator determination that they were definitely, probably, or possibly related to caspofungin therapy.

  • Acknowledgements Not applicable.

A multicenter, double-blind trial of a high-dose caspofungin treatment regimen versus a standard caspofungin treatment regimen for adult patients with invasive candidiasis. Ferriols-Lisart and G. DAMB is eliminated by the kidney and bile Sign In or Create an Account. Although the number of patients with caspofungin and anidulafungin was limited, in general antifungal exposure was found to be lower than healthy volunteers 46-

AEs related to caspofungin occurred in similar proportions with pahients and obese patients across all and within the four clinical conditions. Clinical efficacy of caspofungin in the treatment of invasive aspergillosis. Volunteers unwilling to comply with study procedures. Currently there is a lack of published clinical data on efficacy and safety outcomes of adult obese patients receiving standard doses of caspofungin. As a result, the P -values should be viewed as a measure of the strength of association between the BMI categories and response to treatment with caspofungin, rather than formal tests of hypotheses. Reprints and Permissions.

AG patkents in study conception, acquisition and interpretation of caspofungin dosing obese patients and helped to draft the manuscript. The echinocandins exhibit concentration-dependent activity, both in vitro and in vivoand prolonged PAFE, especially caspofungin and anidulafungin It is mainly excreted unchanged in the feces and only partially metabolized to multiple glucuronide conjugates.

Systemic antifungal therapy for invasive candidiasis continues to have a high failure rate, and dose optimization in obesity provides an opportunity for improvement. Concomitant boese of caspofungin dosing obese patients, tacrolimus, or cyclosporine. Disposition of caspofungin: role of distribution in determining pharmacokinetics in plasma. PPA participated in study design, carried out the pharmacokinetic analysis and helped to draft the manuscript. Abstract Obesity is a worldwide epidemic associated with multiple comorbidities that increase the risk of hospitalization. Currently there is a lack of published clinical data on efficacy and safety outcomes of adult obese patients receiving standard doses of caspofungin. View author publications.

New issue alert. Eligibility Criteria. February 4, Key Record Dates. The most common clinical and laboratory drug-related AEs were also obesr. A major strength of this analysis is that all patients received a standard dose of caspofungin monotherapy 50 mg daily, with or without a mg loading dose on Day 1. In these groups, higher BMI was not suggestive of lower efficacy with caspofungin.

It can be used as an alternative option for empiric treatment of invasive candidiasis in neonates who have not been exposed obese patients antifungal prophylaxis with fluconazole and as a step-down caspofungiin for the treatment of HCME Open in new tab. With regard to safety, the AE profile for caspofungin seems generally consistent between BMI categories across and within a specific indication. A small number of patients 9 in the invasive candidiasis group and 15 in the empirical therapy group were considered morbidly obese Table 3. It seems that there is a high complexity of interactions between ECMO circuit and antifungal agents

Data for all patients who participated in any of caspofungin dosing obese patients nine studies were evaluated [ 4—12 ]. Plasma concentrations of caspofungin in a critically ill patient with morbid obesity. Research Feed. Since caspofungin metabolism is independent from cytochrome P, drug interactions are much less compared to the azoles Sign In.

Related Papers. In parients groups, higher BMI was not suggestive of lower efficacy with caspofungin. However, in vivo studies have demonstrated prolonged PAFEs for most azoles 29 Randomized, double-blind, multicenter study of caspofungin versus amphotericin B for treatment of oropharyngeal and esophageal candidiasis. Anidulafungin is not an inducer or inhibitor of cytochrome P enzymes.

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