Efficacy of Caspofungin in the Treatment of Esophageal Candidiasis Resistant to Fluconazole

Kartsonis, Nicholas; DiNubile, Mark J.; Bartizal, Ken; Hicks, Patricia Scott; Ryan, Desmond; Sable, Carole A.

doi:10.1097/00126334-200210010-00009

Cited by 77Antifungal resistance and susceptibilityFungal Plant Pathogen ControlOcular Infections and Treatments

Efficacy of Caspofungin in the Treatment of Esophageal Candidiasis Resistant to Fluconazole

Kartsonis, Nicholas, DiNubile, Mark J., Bartizal, Ken, Hicks, Patricia Scott, Ryan, Desmond, Sable, Carole A.·2002·JAIDS Journal of Acquired Immune Deficiency Syndromes

DOI 10.1097/00126334-200210010-00009

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Abstract

Caspofungin is a new echinocandin drug with comparable in vitro activity against azole-susceptible and -resistant isolates of that could provide a less toxic alternative to amphotericin B for the management of esophageal candidiasis with clinical or laboratory evidence of decreased susceptibility to fluconazole. The authors retrospectively analyzed its efficacy in adults with endoscopically documented esophagitis from four Phase II and III studies using two definitions of resistance to fluconazole: 1) clinically refractory infection based on failure of esophageal symptoms to improve despite at least 1 week of >or=200 mg/d of fluconazole; or 2) microbiologically resistant infection with either "susceptible dose-dependent" or "resistant" isolates based on MICs of 16 to 32 and >or=64 microg fluconazole/mL, respectively. A favorable response required resolution of all symptoms and substantial improvement in endoscopic findings. Seven of 11 patients (64%) who had been clinically refractory to fluconazole had favorable responses to caspofungin. Eleven of 14 patients (79%) whose isolates had decreased susceptibility to fluconazole had favorable responses to caspofungin, including 5 (83%) of 6 patients infected by isolates with MICs of >or=64 microg fluconazole/mL. Caspofungin appeared to be efficacious therapy for some patients with esophageal candidiasis who were clinically refractory to fluconazole or infected by with reduced susceptibility to fluconazole in vitro.

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Caspofungin was effective in 72% of patients with fluconazole-resistant esophageal candidiasis.
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From Guidelines for Treatment of Candidiasis (2004) · cites this paper as [61]

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Authors: Kartsonis, N., DiNubile, M. J., Bartizal, K., Hicks, P. S., Ryan, D., & Sable, C. A.
Affiliations: Merck & Co., Inc., Rahway, NJ, USA (United States) (US)
Corresponding author: DiNubile, Mark J.
ORCID: Bartizal, Ken
Venue: JAIDS Journal of Acquired Immune Deficiency Syndromes
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2002-10
Volume: 31
Issue: 2
Pages: 183-187
ISSN: 1525-4135 (ISSN-L)
DOI: 10.1097/00126334-200210010-00009
OpenAlex: W2313866636
Cited by: 77
References: 33
Citations by year: 2025: 1 · 2024: 1 · 2021: 1 · 2020: 1 · 2019: 2 · 2017: 1 · 2015: 3 · 2014: 4 · 2013: 1 · 2012: 6
FWCI: 6.09
Type: journal article
Language: en
Open access: closed
Locations: JAIDS Journal of Acquired Immune Deficiency Syndromes (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
Life Sciences › Agricultural and Biological Sciences › Ecology, Evolution, Behavior and Systematics › Fungal Plant Pathogen Control
Health Sciences › Medicine › Ophthalmology › Ocular Infections and Treatments
Keywords: caspofungin, esophageal candidiasis, fluconazole resistance, echinocandins, esophagitis, antifungal therapy, fluconazole susceptibility, HIV-associated candidiasis
MeSH terms: Caspofungin, Adult, Anti-Bacterial Agents, Antifungal Agents, Candida, Candidiasis, Dose-Response Relationship, Drug, Esophageal Diseases, Esophagoscopy, Female, Humans, Infusions, Parenteral, Male, Microbial Sensitivity Tests, Middle Aged, Peptides, Peptides, Cyclic, Retrospective Studies, Cohort Studies, Fluconazole, Treatment Outcome, Drug Resistance, Fungal, Echinocandins, Lipopeptides

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Efficacy of Caspofungin in the Treatment of Esophageal Candidiasis Resistant to Fluconazole

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