Pharmacokinetics of caspofungin and voriconazole in critically ill patients during extracorporeal membrane oxygenation

Abstract

Our results suggest that adequate caspofungin plasma levels are maintained during ECMO. In the case of voriconazole, it is recommended to monitor plasma levels to ensure efficacy and avoid toxicity.

Echinocandin Susceptibility Testing of Candida Isolates Collected during a 1-Year Period in Sweden

“…C. parapsilosis has low virulence in animal models (4), and clinical data suggest that infections caused by this species are less severe than those caused by other Candida species, as they are associated with lower rates of mortality, neutropenia, corticosteroid therapy, and hospitalization (2,18,20). Previous echinocandin use may predispose patients to C. parapsilosis (8,19,35). Thus, the higher anidulafungin MIC values for C. guilliermondii than micafungin MICs in our study may be of clinical relevance, although the general perception has been that susceptibility to the three compounds of the echinocandin class of drugs is uniform.…”

How severe is antibiotic pharmacokinetic variability in critically ill patients and what can be done about it?

“…5 presence of an extra-corporeal circuit (Dodge et al 1994;Mulla et al 2000;Mehta et al 2007;Spriet et al 2009). …”

Pharmacokinetics of caspofungin in a critically ill patient with liver cirrhosis

“…Caspofungin steady state trough (C 24h ) and peak (C 1h ) plasma levels were determined on days 13 and 14 of treatment with a previously validated HPLC-UV method [3]. Troughs and peaks were 3.81 and 3.88 mg/L and 8.01 and 9.07 mg/L, respectively on days 13 and 14.…”

“…Troughs and peaks were 3.81 and 3.88 mg/L and 8.01 and 9.07 mg/L, respectively on days 13 and 14. PK parameters were calculated on the mean trough and peak levels as described previously and shown in Table I [3]. The patient's liver function tests remained stable during treatment with caspofungin, and the serum Aspergillus antigen gradually decreased, which was interpreted as a good antifungal response without systemic toxicity.…”