micafungin and Pleural-Effusion

The distribution of micafungin (MCFG) in tissue fluids, such as cerebrospinal fluid (CSF), pleural effusions, ascites, and wound tissue fluids, was examined in seven patients with invasive fungal infections. MCFG (100-300 mg) was administered once daily over a 1-h intravenous infusion. Blood and tissue fluid samples were collected from 1 to 24 h after infusion. Although two patients had similar MCFG concentrations in their plasma, the concentrations in the CSF differed between these two patients. The concentration in the CSF of one patient was much higher than the MIC(90) for Candida albicans, Candida glabrata, and Aspergillus fumigatus, whereas the MCFG concentration in the CSF of the other patient was comparable to the MIC(90). By contrast, MCFG concentrations in pleural effusions, ascites, and wound tissue fluids were above the MIC(90). These results suggest that intravenous MCFG may be effective to treat invasive fungal infections that invade the organs and tissues.

Topics: Aged; Aged, 80 and over; Antifungal Agents; Ascites; Body Fluids; Echinocandins; Female; Humans; Lipopeptides; Male; Micafungin; Middle Aged; Mycoses; Pleural Effusion; Tissue Distribution

A 62-year-old man with empyema caused by Aspergillus fumigatus was successfully treated with a combination of voriconazole (VRCZ) and micafungin (MCFG). Data regarding the penetration of antifungal agents into pleural fluid are limited. Thus, we measured the concentration of VRCZ and MCFG in his plasma and pleural fluid. Penetration of VRCZ and MCFG into the pleural fluid was excellent. Therefore, the combination therapy using VRCZ and MCFG may contribute to successful management of Aspergillus empyema.

Topics: Aspergillus fumigatus; Drug Therapy, Combination; Echinocandins; Empyema, Pleural; Humans; Lipopeptides; Male; Micafungin; Middle Aged; Pleural Effusion; Pulmonary Aspergillosis; Pyrimidines; Triazoles; Voriconazole