Journal Article

Micafungin versus caspofungin in the treatment of Candida glabrata infection: a case report

Yusuke Tomita, Tomotsugu Yamaguchi, Toshiaki Matsuki, Shoko M. Yamada

2016

Overview

Background Micafungin and caspofungin, which are both echinocandins, elicit their antifungal effects by suppressing the synthesis of β-D-glucan, an essential component of fungal cell walls. If micafungin is not effective against a fungal infection, is it unreasonable to switch to caspofungin? Case presentation An 80-year-old Asian man presented to our hospital with brain and lung abscesses. Klebsiella pneumonia and Escherichia coli were identified by sputa culture and Streptococcus mitis was identified in the brain abscess culture obtained by drainage surgery. He was treated with antibiotics and both abscesses shrank after the treatment. But he continued to have a high fever and Candida glabrata was identified by blood culture. The origin of the infection was not clarified and micafungin was administered intravenously. The fungus showed poor susceptibility to micafungin; we then switched the antifungal from micafungin to caspofungin. After caspofungin treatment, his body temperature remained below 37 °C and his β-D-glucan levels decreased remarkably. Conclusions In vitro , micafungin is considered more effective against C. glabrata because its minimum inhibitory concentration against C. glabrata is lower than that of caspofungin. However, in vivo , there is no significantly different effect between the two drugs. When micafungin is not effective against candidiasis, a switch to caspofungin might be applicable because the pharmacokinetics in each echinocandin is slightly different.

• Publisher: Springer Science and Business Media LLC,BioMed Central,BioMed Central Ltd,Springer Nature B.V
• Subject: Aged, 80 and over / Antifungal Agents / Antifungal Agents - therapeutic use / Brain Abscess / Brain Abscess - drug therapy / Brain Abscess - microbiology / Brain Abscess - pathology / Candida glabrata / Candida glabrata - isolation & purification / Candidiasis / Candidiasis - drug therapy / Candidiasis - microbiology / Candidiasis - pathology / Case Report / Caspofungin / Comparative analysis / Disease / Drug therapy / Echinocandins / Echinocandins - therapeutic use / Family Medicine / Fever / Fever - drug therapy / Fever - microbiology / General Practice / Humans / Internal Medicine / Lipopeptides / Lipopeptides - therapeutic use / Lung Abscess / Lung Abscess - drug therapy / Lung Abscess - microbiology / Lung Abscess - pathology / Male / Medical treatment / Medicine / Medicine & Public Health / Medicine(all) / Micafungin / Primary Care Medicine / Public Health / Surgical Oncology / Treatment Outcome