micafungin and Kidney-Failure--Chronic

The echinocandins have a growing role in the treatment of fungal infections because of their novel mechanism of action. This is reflected in recently published management guidelines, but available in vitro data, animal studies, and clinical studies do not clearly differentiate the three agents in class. Comparative clinical efficacy among agents within the class, pharmacokinetic profiles in special populations, pharmacoeconomics justifications, and place in therapy have been largely unanswered. They share many common properties but marketing strategies of drug manufacturers are engaged in product differentiation. Although exist similarities in the pharmacokinetic (PK) profiles of the echinocandins, limited data have been published regarding their pharmacokinetics in continuous renal replacement therapy (CRRT) patients. The pharmacokinetics of drug removal in critically ill patients receiving CRRT is very complex, with multiple variables affecting clearance. This review outlines the basic principles that determine whether a dose adjustment is required. Two studies with data on PK parameters of micafungin and anidulafungin in CRRT patients have been published and are compared following that basic principles in the review.

Topics: Adsorption; Antifungal Agents; Caspofungin; Critical Illness; Echinocandins; Hemodiafiltration; Hemofiltration; Humans; Kidney Failure, Chronic; Lipopeptides; Membranes, Artificial; Metabolic Clearance Rate; Micafungin; Mycoses; Renal Replacement Therapy

The use of extrarenal depuration techniques is increasingly frequent in patients admitted to the ICU. The use of these procedures has been related to a decrease in plasma concentrations of several antimicrobials, among which fluconazole. The activity of antifungal agents depends on achievement on adequate concentrations in plasma and at the site of infection. Micafungin is a new antifungal drug recently introduced in our country.. To review the published experience of pharmacokinetic (PK) parameters of micafungin in patients requiring some type of extrarenal depuration procedures during their stay in the ICU.. Three studies with data on PK parameters of micafungin during the use of this drug in continuous venovenous hemodialysis (2 publications) and continuous hemodiafiltration (1 publication) were retrieved. In all of them, minimal variations in the plasma concentration of micafungin at the entry and exit sites of the hemofilter and a negligible or minimal presence of micafungin in the ultrafiltration fluid were demonstrated.. Adjustment of the doses or the interval between doses of micafungin during the use of extrarenal depuration techniques in critically ill patients admitted to the ICU is not necessary.

Topics: Antifungal Agents; Critical Care; Critical Illness; Echinocandins; Fungi; Hemodiafiltration; Humans; Kidney Failure, Chronic; Lipopeptides; Micafungin; Mycoses; Renal Dialysis; Renal Replacement Therapy

A 49 year-old woman with chronic renal failure (CRF) on continuous ambulatory peritoneal dialysis (CAPD) because of Goodpasture Syndrome was admitted to our hospital since she had a high fever and severe abdominal pain. A diagnosis of peritonitis was made from the physical examination and laboratory findings. The peritonitis was refractory to conventional antibiotics therapy. Candida parapsilosis was detected from dialysite. The peritonitis was aggravated although the antibiotic was changed to an antifungal agent (fluconazole 400mg/day). Fluconazole was replaced to micafungin (MCFG) and the catheter for CAPD was removed. The fungal peritonitis improved dramatically and beta-D glucan was decreased from 104 to 12.6 (pg/ml). No adverse effect was observed after using MCFG. It has been known that fungal peritonitis of CRF patients is refractory to treatment and the mortality rate is high. To our best knowledge, there is no report that MCFG was used for CRF patients with fungal peritonitis. However, we used MCFG safely and effectively for CRF patients. Therefore, it is suggested that MCFG is a new effective and safe antifungal agent for Candida parapsilosis peritonitis with CRF.

Topics: Antifungal Agents; Candida; Candidiasis; Echinocandins; Female; Humans; Kidney Failure, Chronic; Lipopeptides; Lipoproteins; Micafungin; Middle Aged; Peptides, Cyclic; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis