J Med Microbiol Track the topics, authors and articles important to you
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Ellis, M.
Right arrow Articles by Shammas, F.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Ellis, M.
Right arrow Articles by Shammas, F.
Agricola
Right arrow Articles by Ellis, M.
Right arrow Articles by Shammas, F.
J Med Microbiol 55 (2006), 1357-1365; DOI: 10.1099/jmm.0.46452-0
© 2006 Society for General Microbiology
ISSN 1473-5644

An open study of the comparative efficacy and safety of caspofungin and liposomal amphotericin B in treating invasive fungal infections or febrile neutropenia in patients with haematological malignancy

Michael Ellis1,2, Chris Frampton3, Jose Joseph4, Hussain Alizadeh1,2, Jorgen Kristensen1,2, Anders Hauggaard5 and Fuad Shammas1,2

1 ,3 Medicine1 and Community Medicine3 , UAE University Faculty of Medicine and Health Sciences, Al-Ain, Abu Dhabi, United Arab Emirates

2 ,5 Oncology and Haematology2 and Radiology5 , Tawam Hospital, Al-Ain, Abu Dhabi, United Arab Emirates

4 Pulmonary and Critical Care Division, UCSF Fresno School of Medicine, 445 S Cedar Ave., Fresno, CA 93702, USA

Correspondence
Michael Ellis
michael.ellis{at}uaeu.ac.ae

Received 5 December 2005
Accepted 12 May 2006

In a clinical non-trial setting, the efficacy and safety of caspofungin was compared with liposomal amphotericin B for the management of febrile neutropenia or invasive fungal infections in 73 episodes in patients with haematological malignancy. There were fewer episodes of drug toxicity with caspofungin than liposomal amphotericin B (58.3 vs 83.7 %, P=0.02). The favourable response rate for episodes of febrile neutropenia treated with caspofungin or liposomal amphotericin B was similar at 37.5 and 53.8 %, respectively, but more breakthrough fungal infections occurred with caspofungin than with liposomal amphotericin B (33.3 vs 0 %, P<0.05) in these patients who did not receive antifungal prophylaxis. None of four episodes of candidaemia or hepatosplenic candidiasis responded to caspofungin compared with three of four episodes treated with liposomal amphotericin B. Mortality was significantly higher with caspofungin treatment compared with liposomal amphotericin B (6/24 vs 2/49, P=0.01), mainly due to an excess of fungal infections (P=0.04). Caspofungin treatment was a significant independent predictor of mortality [odds ratio=7.6 (95 % confidence interval 1.2–45.5)] when sepsis severity, prolonged neutropenia and length of antifungal therapy were considered in a multiple logistic regression model. In clinical practice, there is a suggestion that caspofungin may not be as effective as liposomal amphotericin B in preventing breakthrough invasive fungal infections in febrile neutropenia or in preventing fungus-related deaths. Because of the potential biases in this observational study, these preliminary findings should be interpreted with caution and clarified with a larger cohort of patients.

Abbreviations: ALL, acute lymphocytic leukaemia; AML, acute myeloid leukaemia; CT, computed tomography; IFI, invasive fungal infection; IPA, invasive pulmonary aspergillosis; NF, neutropenic fever unresponsive to broad-spectrum antibiotics.






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
INT J SYST EVOL MICROBIOL J MED MICROBIOL MICROBIOLOGY J GEN VIROL ALL SGM JOURNALS
Copyright © 2006 Society for General Microbiology.