The Annals of Pharmacotherapy: Vol. 37, No. 12, pp. 1919. DOI 10.1345/aph.1C114b
© 2003 Harvey Whitney Books Company.
Comment: caspofungin acetate for treatment of invasive fungal infections
Santiago Grau, PhD
Infectious Diseases Pharmacist Department of Pharmacy Hospital del
Mar Passeig Marítim, 25–29 08003 Barcelona Spain FAX 349 324
83256
sgrau{at}imas.imim.es
Javier Mateu-de Antonio, PharmD
Clinical Pharmacist Department of Pharmacy Hospital del
Mar
Published Online, October 15, 2003. www.theannals.com, DOI 10.1345/aph.1C114b
TO THE EDITOR: Pacetti and
Gelone1 wrote
an interesting review about the new antifungal caspofungin acetate, which was
then further addressed by
Chan.2 Chan
described in vitro and animal studies showing increased effectiveness of
caspofungin in combination with other antifungals against some fungi, mainly
Aspergillus fumigatus. Other antifungal combinations also presented
good results in vitro against Aspergillus
spp.3
However, until now, the experience of using such combinations is very scarce
in humans. The only recommended combination by the Infectious Diseases Society
of America is amphotericin B plus flucytosine for the treatment of
cryptococcal meningitis in patients with HIV and, for some patients, severe
candida
infections.4,5
Few human cases of caspofungin combinations with successful outcomes have
been reported. One described 2 patients with invasive aspergillosis healed
with caspofungin plus
itraconazole.6
Another reported that 2 of 3 patients with invasive aspergillosis and 4 of 4
patients with invasive candidiasis were successfully treated with caspofungin
plus amphotericin B
desoxycholate.7
Finally, a retrospective study evaluated 35 patients with refractory
Aspergillus pneumonia in acute leukemia treated with caspofungin
added to amphotericin B desoxycholate or liposomal amphotericin
B.8
Successful outcome was reported in 60% of these patients.
The new antifungals, caspofungin and voriconazole, could change the therapy
of invasive fungal infections. The published papers of antifungal combinations
in humans seem to show a promising approach in these fungal infections with
high mortality rates. Even so, this point should be confirmed with
well-designed clinical trials.
References
- Pacetti SA, Gelone SP. Caspofungin acetate for treatment of
invasive fungal infections. Ann Pharmacother 2003;37: 90-8.
DOI 10.1345/aph.1C114[Abstract/Free Full Text]
- Chan J. Comment: caspofungin acetate for treatment of invasive
fungal infections (letter). Ann Pharmacother 2003;37: 595. DOI
10.1345/aph.1C114a[Free Full Text]
- Mosquera J, Sharp A, Moore CB, Warn PA, Denning DW. In vitro
interaction of terbinafine with itraconazole, fluconazole, amphotericin B and
5-flucytosine against Aspergillus spp. J Antimicrob
Chemother 2002;50:189-94.[Abstract/Free Full Text]
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WG, et al. Practice guidelines for the management of cryptococcal disease.Clin Infect Dis
2000;30:710-8.[CrossRef][Medline]
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- Rubin MA, Carroll KC, Cahill BC. Caspofungin in combination with
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2002;34:1160-1.[CrossRef][Medline]
- Nivoix Y, Zamfir A, Lutum P, Kara F, Remy V, Lioure B, et al.Caspofungine plus amphotericine B ou azole dans le traitement de
deuxiéme ligne d'infections fongiques invasives. Revue de 11 cases
(abstract)
. Presented at: Congrès de la Societé
Française de Mycologie Médicale. Institut Pasteur, Paris,
November 29–30, 2002.
- Aliff TB, Maslak PG, Jurcic JG, Heaney ML, Cathcart KN, Sepkowitz
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