Plasma concentrations of caspofungin in a critically ill patient with morbid obesity

Ferriols-Lisart, Rafael; Aguilar, Gerardo; Pérez-Pitarch, Alejandro; Puig, Jaume; Ezquer-Garin, Carlos; Alós, Manuel

doi:10.1186/s13054-017-1774-2

Cited by 8 publications

(2 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Most studies have been performed with caspofungin. In agreement with our results, pharmacokinetic studies with caspofungin showed lower exposure in overweight and obese patients, whether critically ill [ 39 ] or not [ 40 ], and also showed the benefits of increasing the dose in morbidly obese patients [ 41 ]. Similarly, the limited data in the literature regarding the influence of obesity on the pharmacokinetics of anidulafungin confirm the lower anidulafungin exposure in patients with morbid obesity compared with nonobese patients [ 32 ] and the need for increasing the dose in a critically ill morbid obese patient [ 42 ].…”

Section: Discussionsupporting

confidence: 90%

Population pharmacokinetics/pharmacodynamics of micafungin against Candida species in obese, critically ill, and morbidly obese critically ill patients

et al. 2018

View full text Add to dashboard Cite

BackgroundDosing in obese critically ill patients is challenging due to pathophysiological changes derived from obesity and/or critical illness, and it remains fully unexplored. This study estimated the micafungin probability of reaching adequate 24-h area under the curve (AUC0–24h)/minimum inhibitory concentration (MIC) values against Candida spp. for an obese/nonobese, critically ill/noncritically ill, large population.MethodsBlood samples for pharmacokinetic analyses were collected from 10 critically ill nonobese patients, 10 noncritically ill obese patients, and 11 critically ill morbidly obese patients under empirical/directed micafungin treatment. Patients received once daily 100–150 mg micafungin at the discretion of the treating physician following the prescribing information and hospital guidelines. Total micafungin concentrations were determined by high-performance liquid chromatography (HPLC). Monte-Carlo simulations were performed and the probability of target attainment (PTA) was calculated using the AUC0–24/MIC cut-offs 285 (C. parapsilosis), 3000 (all Candida spp.), and 5000 (nonparapsilosis Candida spp.). Intravenous once-daily 100-mg, 150-mg, and 200-mg doses were simulated at different body weights (45, 80, 115, 150, and 185 kg) and age (30, 50, 70 and 90 years old). PTAs ≥ 90% were considered optimal. Fractional target attainment (FTA) was calculated using published MIC distributions. A dosing regimen was considered successful if the FTA was ≥ 90%.ResultsOverall, 100 mg of micafungin was once-daily administered for nonobese and obese patients with body mass index (BMI) ≤ 45 kg/m2 and 150 mg for morbidly obese patients with BMI > 45 kg/m2 (except two noncritically ill obese patients with BMI ~ 35 kg/m2 receiving 150 mg, and one critically ill patient with BMI > 45 kg/m2 receiving 100 mg). Micafungin concentrations in plasma were best described using a two-compartment model. Weight and age (but not severity score) were significant covariates and improved the model. FTAs > 90% were obtained against C. albicans with the 200 mg/24 h dose for all body weights (up to 185 kg), and with the 150 mg/24 h for body weights < 115 kg, and against C. glabrata with the 200 mg/24 h dose for body weights < 115 kg.ConclusionThe lack of adequacy for the 100 mg/24 h dose suggested the need to increase the dose to 150 mg/24 h for C. albicans infections. Further pharmacokinetic/pharmacodynamic studies should address optimization of micafungin dosing for nonalbicans Candida infections.

show abstract

Section: Discussionsupporting

confidence: 90%

Population pharmacokinetics/pharmacodynamics of micafungin against Candida species in obese, critically ill, and morbidly obese critically ill patients

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Echinocandins Caspofungin, micafungin, and anidulafungin have demonstrated concentrationdependent reduction of fungal growth [38], with the AUC/MIC ratio used as the PK/PD target [39]. Some studies have reported suboptimal dosing of echinocandins at the current recommended doses in specific groups, such as critically ill and obese patients, due to PK variability [40][41][42][43][44][45][46][47][48][49]. Higher loading doses (LD) and maintenance doses (MD) were necessary to achieve the PK and pharmacodynamic (PD) targets.…”

Section: Tdm In Obesementioning

confidence: 99%

Therapeutic Drug Monitoring of Antimicrobials in Critically Ill Obese Patients

Gorham¹,

Taccone²,

Hites³

2023

Antibiotics

View full text Add to dashboard Cite

Obesity is a significant global public health concern that is associated with an elevated risk of comorbidities as well as severe postoperative and nosocomial infections. The treatment of infections in critically ill obese patients can be challenging because obesity affects the pharmacokinetics and pharmacodynamics of antibiotics, leading to an increased risk of antibiotic therapy failure and toxicity due to inappropriate dosages. Precision dosing of antibiotics using therapeutic drug monitoring may help to improve the management of this patient population. This narrative review outlines the pharmacokinetic and pharmacodynamic changes that result from obesity and provides a comprehensive critical review of the current available data on dosage adjustment of antibiotics in critically ill obese patients.

show abstract

Drug-Nutrition Interactions in Infectious Diseases

Boullata

2020

Nutrition and Infectious Diseases

View full text Add to dashboard Cite

Plasma concentrations of caspofungin in a critically ill patient with morbid obesity

Cited by 8 publications

References 5 publications

Population pharmacokinetics/pharmacodynamics of micafungin against Candida species in obese, critically ill, and morbidly obese critically ill patients

Population pharmacokinetics/pharmacodynamics of micafungin against Candida species in obese, critically ill, and morbidly obese critically ill patients

Therapeutic Drug Monitoring of Antimicrobials in Critically Ill Obese Patients

Drug-Nutrition Interactions in Infectious Diseases

Contact Info

Product

Resources

About