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Case 3
Published in Atul B. Mehta, Keith Gomez, Clinical Haematology, 2017
Every attempt must be made to make a microbiological diagnosis (blood cultures, culture of aspirate from skin, sputum culture, possibly bronchoalveolar lavage). She should receive broad-spectrum antibiotic and anti-fungal therapy, and this should include systemic liposomal amphotericin or some other lipid formulation of amphotericin B. Oral itraconazole is used as prophylaxis and intravenous itraconazole is active in the treatment of aspergillosis. Caspofungin is a newer anti-fungal agent active in both candidiasis and aspergillosis. Voriconozole has a broader spectrum of activity; posaconazole has recently become available for prophylaxis and treatment for invasive fungal infections in immunocompromised individuals.
Caspofungin
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Russell E. Lewis, Nicholas D. Beyda, Dimitrios P. Kontoyiannis
Caspofungin is not orally bioavailable and must be administered parenterally. Caspofungin for injection (Cancidas, Merck & Co.) is provided as sterile powder/cake in single-dose vials (50 and 70 mg) that is reconstituted and diluted for administration with sodium chloride to 250 ml and administered as a 1-hour infusion. Unopened vials of caspofungin should be stored at 4 °C. Reconstituted solution may be stored for up to an hour at 25 °C, and diluted product can be stored at 25 °C for 24 hours or 4 °C for 48 hours (Cancidas, 2015). Caspofungin must be administered by slow (1–2 hours) intravenous infusion. In general, caspofungin should not be mixed with other medications unless the drug compatibility has been previously documented. Caspofungin is incompatible with diluents containing dextrose (α-d-glucose).
Antifungal Drugs
Published in Thomas T. Yoshikawa, Shobita Rajagopalan, Antibiotic Therapy for Geriatric Patients, 2005
Caspofungin is given as an IV infusion once daily over an hour. A loading dosage of 70 mg is given the first day, followed by a daily dosage of 50 mg. Infusion-related reactions, including chills, fever, and flushing have been reported and can be obviated by slowing the infusion time and giving an antihistamine, such as diphenhydramine.
Caspofungin: a review of its characteristics, activity, and use in intensive care units
Published in Expert Review of Anti-infective Therapy, 2020
Seyed MohammadReza Hashemian, Tayebeh Farhadi, Ali Akbar Velayati
Generally, echinocandins are well tolerated and have a promising safety profile compared to other antifungals. However, they may show some adverse effects. Micafungin may have a risk to develop possibly liver tumors [28]. Infusion associated reactions may happen after administration of echinocandins that can be managed using antihistamines [28]. Thrombophlebitis may especially take place in HIV infected patients. However, in patients with granulocytopenia and persistent fever, infusion-related reactions following administration of echinocandins were less than liposomal amphotericin [34]. Caspofungin has a greater incidence of liver-associated laboratory abnormalities (about 1 to 15%) compared to anidulafungin and micafungin [35]. In rare cases, administration of caspofungin may cause mild gastrointestinal symptoms such as vomiting, nausea diarrhea, and so on [28,36].
Effect of drug combination on tacrolimus target dose in renal transplant patients with different CYP3A5 genotypes
Published in Xenobiotica, 2022
Shu-Fang Zhang, Bo-Hao Tang, An-hua Wei, Yue Du, Zi-Wan Guan, Yan Li
Our model is, to our knowledge, the first to include as covariates the co-administration of caspofungin or micafungin, which are also metabolised by the CYP3A enzyme. Caspofungin reduces the blood concentration of tacrolimus by approximately 26% (Shi and Ju 2019). However, we found no effect of these two echinocandins on the CL of tacrolimus in renal transplant recipients. The reasons may be that the sample size of patients taking tacrolimus in combination with caspofungin/micafungin was small and therefore insufficient to draw valid conclusions. The small sample is perhaps the primary limitation of the present study. Larger studies are needed to verify whether caspofungin and micafungin interact with tacrolimus.
Virtual screening for potential inhibitors of β(1,3)-D-glucan synthase as drug candidates against fungal cell wall
Published in Journal of Drug Assessment, 2020
Zinat Farhadi, Tayebeh Farhadi, Seyed MohammadReza Hashemian
Invasive candidiasis has been considered a significant reason of death in immuno-compromised and critically ill patients1–6. Invasive candidiasis can initially be managed in critically ill patients by utilizing an echinocandin, e.g. caspofungin7,8. Caspofungin inhibits the enzyme β(1,3)-D-glucan synthase of the fungal cell wall in a non-competitive manner leading to inhibition of the synthesis of β(1,3)-D-glucan. β(1,3)-D-glucan is a crucial element of the cell wall of many fungal species and forms a solid three-dimensional matrix that is involved in shape determination and mechanical strength of the cell wall9,10.