Caspoced
Caspofungin 50mg / 70mg Injection
Indications, Dosage and Administration
Caspofungin should be administered by slow intravenous (IV) Infusion over approximately 1 hour. It should not be administered by IV bolus administration.
INDICATIONS
| Indications | Dosage Adults (18 years of age or older) |
|---|---|
| Empirical therapy for presumed fungal infections in Febrile neutronpenic patients | A single 70mg loading dose on Day 1, followed by 50mg OD thereafter |
| Treatment of Candidaemia and the following Candida infections: intra-abdominal abscesses, peritonitis and pleural space infections. | A single 70mg loading dose on Day 1, followed by 50mg OD thereafter |
| Treatment of Invasive Aspergillosis in patients, who are refractory to or intolerant of other therapies (i.e. amphotericin B, lipid formulations of amphotericin B, itraconazole). | A single 70mg loading dose on Day 1, followed by 50mg OD thereafter. |
| Treatment of Oesophageal Candidiasis. | 50mg OD for 7 to 14 days aŌer sypmtom resolution. |
OD=once in a day
- Duration of treatment should be based on the patient’s clinical response. Continue empirical therapy until resolution of neutropenia.
- Duration of treatment should be dictated by the patient’s clinical and microbiological response.
- Duration of treatment should be based upon the severity of the patient’s underlying disease, recovery from immunosuppression and clinical response.
To Compare the Efficacy of Caspofungin Vs Fluconazole Prophylaxis on Invasive Fungal Disease Among Children and Young Adults With Acute Myeloid Leukemia (AML)
METHODS:
- Caspofungin dose of 70mg / m per day was administered intravenously on day 1 (maximum dose 70mg / d followed by 50mg / m per day (maximum dose 50mg / d). ² ² 1
- Fluconazole was determined as follows: participants whose age ranged from 3 months or older to 17.99 years received 12mg / kg once daily (maximum dose 400 mg/d) and from age 18 to 30 years, 6 mg/kg once daily (maximum dose 400 mg/d) either intravenously or orally.
RESULTS
- The 5-month cumulative incidence of proven or probable invasive fungal disease was 3.1% (95% CI, 1.3%-7%), in the caspofungin group vs 7.2% (95% CI, 4.4%-11.8%) in the fluconazole group (overall P =0.03 by log-rank test.
- Cumulative incidence of proven or probable invasive aspergillosis was 0.5% (95% CI, 0.1%-3.5%) with caspofungin vs 3.1% (95% CI, 1.4%-6.9%) with fluconazole (overall P = 0.046 by log-rank test).
- There is no statistically significant changes in empirical antifungal therapy (71.9% caspofungin vs 69.5% floconazole, overall P = 0.78 by log-rank test) or 2 year overall survival (68.8% caspofungin vs 70.8% fluconazole, overall P = 0.66 by log rank test) were observed.
CONCLUSION
When compared to fluconazole , caspofungin prophylaxis resulted in a considerably lower incidence of invasive fungal illness in children, adolescents, and young adults with acute myeloid leukaemia. The results advocate that caspofungin may be considered for prophylaxis against invasive fungal disease.
Although study interpretation is limited by early termination due to an unplanned interim analysis that appeared to have suggested futility. Fisher BT, Zaoutis T, Dvorak CC, et al. Effect of Caspofungin vs Fluconazole Prophylaxis on Invasive Fungal Disease Among Children and Young Adults with Acute Myeloid Leukemia: A Randomized Clinical Trial. JAMA. 2019; 322(17) : 1673-1681.
Strongly recommended with strong to moderate-quality evidence
Clinical Practice Guideline for the Management of Candidiasis & Aspergillosis : 2016 Update by the Infectious Diseases Society of America
| Conditions (Candidiasis) | Therapy | Recommendations |
|---|---|---|
| Candidemia in Non- Neutropenic Patients | Initial therapy-Caspofungin: Loading dose 70mg, then 50mg daily | Strong recommendation; High-quality evidence |
| Candidemia in Neutropenic Patients | Initial therapy-Caspofungin: Loading dose 70mg, then 50mg daily | Strong recommendation; Moderate-quality evidence |
| Empiric Treatment for Suspected I n v a s i v e C a n d i d i a s i s i n N o n - Neutropenic Patients in the ICU | Caspofungin: Loading dose 70mg, then 50mg daily | Strong recommendation; Moderate-quality evidence |
| Esophageal Candidiasis | Caspofungin: Loading dose 70mg, then 50mg daily | Strong recommendation; High-quality evidence |
| Condition (Aspergillosis) | Therapy | Recommendations |
|---|---|---|
| High-risk patients with prolonged neutropenia who remain persistently febrile despite broad-spectrum antibiotic therapy | Caspofungin | Strong recommendation; High-quality evidence |