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Zhou ZX, Yin XD, Zhang Y, Shao QH, Mao XY, Hu WJ, Shen YL, Zhao B, Li ZL. Antifungal Drugs and Drug-Induced Liver Injury: A Real-World Study Leveraging the FDA Adverse Event Reporting System Database. Front Pharmacol 2022; 13:891336. [PMID: 35571077 PMCID: PMC9098189 DOI: 10.3389/fphar.2022.891336] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 03/28/2022] [Indexed: 12/02/2022] Open
Abstract
Aims: We aimed to estimate the risk of drug-induced liver injury (DILI) from various antifungal treatments with azoles and echinocandins causing in real-world practice. Methods: We performed disproportionality and Bayesian analyses based on data from the first quarter in 2004 to the third quarter in 2021 in the Food and Drug Administration Adverse Event Reporting System to characterize the signal differences of antifungal drugs-related DILI. We also compared the onset time and mortality differences of different antifungal agents. Results: A total of 2943 antifungal drugs-related DILI were identified. Affected patients tended to be aged >45 years (51.38%), with more males than females (49.03% vs. 38.09%). Antifungal drug-induced liver injury is most commonly reported with voriconazole (32.45%), fluconazole (19.37%), and itraconazole (14.51%). Almost all antifungal drugs were shown to be associated with DILI under disproportionality and Bayesian analyses. The intraclass analysis of correlation between different antifungal agents and DILI showed the following ranking: caspofungin (ROR = 6.12; 95%CI: 5.36–6.98) > anidulafungin (5.15; 3.69–7.18) > itraconazole (5.06; 4.58–5.60) > voriconazole (4.58; 4.29–4.90) > micafungin (4.53; 3.89–5.27) > posaconazole (3.99; 3.47–4.59) > fluconazole (3.19; 2.93–3.47) > ketoconazole (2.28; 1.96–2.64). The onset time of DILI was significantly different among different antifungal drugs (p < 0.0001), and anidulafungin result in the highest mortality rate (50.00%), while ketoconazole has the lowest mortality rate (9.60%). Conclusion: Based on the Food and Drug Administration Adverse Event Reporting System database, antifungal drugs are significantly associated with DILI, and itraconazole and voriconazole had the greatest risk of liver injury. Due to indication bias, more clinical studies are needed to confirm the safety of echinocandins.
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Affiliation(s)
- Zhi-Xuan Zhou
- Department of Pharmacy, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xue-Dong Yin
- Department of Pharmacy, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Zhang
- Department of Pharmacy, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai, China
- Department of Pharmacy, Nanyang Central Hospital, Affiliated Hospital of Zhengzhou University, Nanyang, China
| | - Qi-Hui Shao
- Department of Pharmacy, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xin-Yu Mao
- Department of Pharmacy, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wen-Juan Hu
- Department of Pharmacy, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yun-Lin Shen
- Department of Neonatology, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai, China
- *Correspondence: Yun-Lin Shen, ; Bin Zhao, ; Zhi-Ling Li,
| | - Bin Zhao
- Pharmacy Department, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- *Correspondence: Yun-Lin Shen, ; Bin Zhao, ; Zhi-Ling Li,
| | - Zhi-Ling Li
- Department of Pharmacy, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai, China
- *Correspondence: Yun-Lin Shen, ; Bin Zhao, ; Zhi-Ling Li,
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Invasive pulmonary aspergillosis after liver transplantation: lessons from successfully treated cases and review of the literature. Surg Today 2021; 51:1361-1370. [PMID: 33738584 DOI: 10.1007/s00595-021-02263-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 12/26/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE Invasive pulmonary aspergillosis (IPA) after liver transplantation (LT) is most often fatal. We analyzed the outcomes of IPA in a single center. METHODS We reviewed, retrospectively, the medical records of recipients of living donor LT (LDLT) or deceased donor LT (DDLT) performed between 1995 and 2019 at our institute. We analyzed the incidence of IPA and assessed the treatment courses of patients treated successfully and those not treatment successfully. RESULTS Among 326 recipients, IPA was diagnosed in 6 (1.8%). The incidence of IPA was significantly higher in patients with acute liver failure (ALF, 9.8%) than in those without ALF (0.4%), after DDLT (8.8%) than after LDLT (1.0%), and in recipients who received preoperative steroid pulse therapy (16.0%) than in those who did not (0.7%). Complete cure of IPA was achieved in the most recent three patients, by administering voriconazole immediately after the diagnosis of IPA and performing lung resection, while the IPA lesion was single and localized. CONCLUSIONS Patients with risk factors for IPA must be monitored closely. Our three successfully treated cases demonstrate that initiating immediate voriconazole treatment and making a calculated decision about lung resection can contribute to a favorable outcome.
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Pajer HB, Asher AM, Gelinne A, Northam W, van Duin D, Quinsey CS. Impact of Surgical and Medical Treatment on Survival of Patients with Cerebral Aspergillosis: Systematic Review of the Literature. World Neurosurg 2021; 149:244-248.e13. [PMID: 33482411 DOI: 10.1016/j.wneu.2021.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 01/10/2021] [Accepted: 01/10/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Cerebral aspergillosis carries a high mortality. Rapid diagnosis and treatment can increase survival, but symptoms and imaging findings are nonspecific. The literature on cerebral aspergillosis consists mostly of case reports and case series and lacks large-scale review of data. METHODS We performed a review of the literature using PubMed in March 2019. We recorded the year of publication, age and sex of patients, neurosurgical involvement, the antifungals administered, use of intrathecal antifungals, and the outcome of patients. The relationships among variables were tested using bivariant statics and linear regression. RESULTS A total of 324 studies met the eligibility criteria, and 198 studies including 248 patients were included. Surgical resection (odds ratio [OR], 0.45; 95% confidence interval [CI], 0.25-0.80; P < 0.01) and administration of voriconazole (OR, 0.32; 95% CI, 0.18-0.55; P < 0.001) or itraconazole (OR, 0.36; 95% CI, 0.16-0.72; P < 0.001) were shown to be significantly associated with survival. CONCLUSIONS Given the significant survival benefits for patients who received voriconazole and surgical intervention, we suggest early antifungal medical treatment and resection.
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Affiliation(s)
- Hengameh B Pajer
- Campbell University School of Osteopathic Medicine, Buis Creek, North Carolina, USA
| | - Anthony M Asher
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Aaron Gelinne
- Department of Neurosurgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Weston Northam
- Department of Neurosurgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - David van Duin
- Department of Infectious Disease, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Carolyn S Quinsey
- Department of Neurosurgery, University of North Carolina, Chapel Hill, North Carolina, USA.
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Tverdek FP, Kofteridis D, Kontoyiannis DP. Antifungal agents and liver toxicity: a complex interaction. Expert Rev Anti Infect Ther 2016; 14:765-76. [PMID: 27275514 DOI: 10.1080/14787210.2016.1199272] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The number of antifungal agents has sharply increased in recent decades. Antifungals differ in their spectrum of activity, pharmacokinetic/pharmacodynamic properties, dosing, safety-profiles and costs. Risk of developing antifungal associated hepatotoxicity is multifactorial and is influenced by pre-existing liver disease, chemical properties of the drug, patient demographics, comorbidities, drug-drug interactions, environmental and genetic factors. Antifungal related liver injury typically manifests as elevations in serum aminotransferase levels, although the clinical significance of these biochemical alterations is not always clear. Incidence rates of hepatotoxicity induced by antifungal therapy range widely, occurring most frequently in patients treated with azole antifungals for documented fungal infections. AREAS COVERED This review provides an update regarding the hepatotoxicity profiles of the modern systemic antifungals used in treatment of invasive fungal infections. Expert commentary: Understanding the likelihood and pattern of hepatotoxicity for all suspected drugs can aid the clinician in early detection of liver injury allowing for intervention and potential mitigation of liver damage. Therapeutic drug monitoring is emerging as a potential tool to assess risk for hepatotoxicity.
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Affiliation(s)
- Frank P Tverdek
- a Department of Pharmacy Clinical Programs , The University of Texas M.D. Anderson Cancer Center , Houston , TX , USA
| | - Diamantis Kofteridis
- b Infectious Disease Unit, Department of Internal Medicine , University Hospital of Heraklion , Crete , Greece
| | - Dimitrios P Kontoyiannis
- c Departments of Infectious Diseases , Infection Control and Employee Health, The University of Texas M.D. Anderson Cancer Center , Houston , TX , USA
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Barchiesi F, Mazzocato S, Mazzanti S, Gesuita R, Skrami E, Fiorentini A, Singh N. Invasive aspergillosis in liver transplant recipients: epidemiology, clinical characteristics, treatment, and outcomes in 116 cases. Liver Transpl 2015; 21:204-12. [PMID: 25348192 DOI: 10.1002/lt.24032] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 10/13/2014] [Accepted: 10/19/2014] [Indexed: 12/31/2022]
Abstract
Invasive aspergillosis (IA) in liver transplant recipients is associated with grave outcomes. We reviewed 116 individual cases reported in the literature from 1985 to 2013. IA was diagnosed after a median of 25 days after transplantation and involved a single organ in 51% of the cases, whereas in the remaining cases, multiple sites were involved. The most common infecting Aspergillus species were Aspergillus fumigatus (73%), Aspergillus flavus (14%), and Aspergillus terreus (8%). Amphotericin B was the drug most frequently used, and it was followed by voriconazole and itraconazole. Combination regimens were used in 51% of the cases. The overall 1-year cumulative survival probability was 35% [95% confidence interval (CI) = 24.6%-49.6%]. Survival was significantly higher for patients reported from the year 2000 and thereafter (P < 0.001), for those diagnosed with IA more than 30 days after transplantation versus those diagnosed earlier (P = 0.019), and for patients without renal failure (P = 0.020). Additionally, the use of voriconazole was significantly associated with a higher probability of survival (P < 0.001). Cox regression analysis showed that subjects with the involvement of multiple sites had a 2.52 times higher risk of a negative outcome (95% CI = 1.08-5.87) than those with the involvement of a single site. Thus, IA causes life-threatening infections in liver transplant recipients. Predictors associated with poor outcomes may help clinicians to optimize the management of this infection.
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Affiliation(s)
- Francesco Barchiesi
- Infectious Diseases Clinic, Università Politecnica delle Marche, Ancona, Italy
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Enoch D, Idris S, Aliyu S, Micallef C, Sule O, Karas J. Micafungin for the treatment of invasive aspergillosis. J Infect 2014; 68:507-26. [DOI: 10.1016/j.jinf.2014.01.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 01/06/2014] [Accepted: 01/15/2014] [Indexed: 10/25/2022]
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Cherian T, Giakoustidis A, Yokoyama S, Heneghan M, O’Grady J, Rela M, Wendon J, Heaton DN, Verma A. Treatment of Refractory Cerebral Aspergillosis in a Liver Transplant Recipient With Voriconazole: Case Report and Review of the Literature. EXP CLIN TRANSPLANT 2012; 10:482-6. [DOI: 10.6002/ect.2012.0028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Qin J, Xu J, Dong Y, Tang W, Wu B, An Y, Shan H. High-resolution CT findings of pulmonary infections after orthotopic liver transplantation in 453 patients. Br J Radiol 2012; 85:e959-65. [PMID: 22993384 DOI: 10.1259/bjr/26230943] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The objective of this study was to review the high-resolution CT (HRCT) findings in patients with pulmonary infection after orthotopic liver transplantation (OLT) and to determine distinguishing findings among the various types of infection. METHODS This study included 453 consecutive liver transplant recipients with pulmonary infection, on whom HRCT of the chest was performed within 24 h of the beginning of symptoms and for whom proven diagnosis had taken place within 1 week of the onset of symptoms. Two radiologists analysed the CT images; final decisions regarding the findings were reached by consensus. RESULTS Bacterial and viral pneumonia made up the bulk of infections (63.4% and 29.4%, respectively), followed by fungal infiltrates (24.5%). Large nodules were most common in patients with fungal pneumonia, having been seen in 38 (54%) of the 70 patients with fungal pneumonia, 22 (10%) of 220 with bacterial pneumonia (p=0.0059) and 6 (8%) of 78 with viral pneumonia (p=0.0011). The halo sign was also more frequent in patients with fungal pneumonia, having been seen in 38 (54%) of the 70 patients with fungal pneumonia, 17 (8%) of 220 with bacterial pneumonia (p=0.0026) and 7 (9%) of 78 with viral pneumonia (p=0.0015). There was no statistically significant difference in the prevalence of the other HRCT patterns including air-space consolidation, ground-glass attenuation and small nodules among bacterial, viral and fungal infections (all p>0.05). CONCLUSION The presence of large nodules with the halo sign is most suggestive of fungal infection after OLT. Other HRCT patterns are not helpful in distinguishing among the various types of infection seen in liver transplant recipients.
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Affiliation(s)
- J Qin
- Department of Radiology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Qin J, Fang Y, Dong Y, Zhu K, Wu B, An Y, Shan H. Radiological and clinical findings of 25 patients with invasive pulmonary aspergillosis: retrospective analysis of 2150 liver transplantation cases. Br J Radiol 2012; 85:e429-35. [PMID: 22496071 DOI: 10.1259/bjr/39784231] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the radiological and clinical findings of invasive pulmonary aspergillosis (IPA) after liver transplantation. METHODS This study included 25 consecutive liver transplant recipients with histologically confirmed IPA after liver transplantation. Radiological examinations performed for diagnosis were available in all patients. Clinical findings and changes in clinical response and radiological findings after treatment were also evaluated. RESULTS 3 main radiological findings were identified: nodules, 64% (16/25); masses, 36% (9/25); and consolidations in a patchy pattern, 20% (5/25). A tree-in-bud pattern was found in 12% (3/25) of patients. In 8 (32%) of 25 patients, we found a combination of 2 or more of these signs: 5 (20%) patients presented with concurrent nodules accompanied by patchy consolidations and/or tree-in-bud, and 3 (12%) patients showed masses accompanied by large consolidations. A halo sign was observed in 20 (80%) of 25 patients. Hypodense sign and cavitary lesions were encountered in 17 (68%) of 25 patients. Follow-up radiological findings after treatment showed improvement in 18 patients, no change in 4 patients and progression in 3 patients. There were three aspergillosis-associated deaths during the follow-up period. The onset time of IPA was a median of 31 days after transplantation. The most common symptom at diagnosis was fever (n=15). None of the 25 patients had leukopaenia at the time of the diagnosis of IPA. CONCLUSIONS The most common radiological findings of IPA after liver transplantation are multiple nodules with or without halo sign, masses and consolidations, which usually appear about 1 month after transplantation.
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Affiliation(s)
- J Qin
- Department of Radiology/Institute of Interventional Radiology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Computed Tomography and Clinical Features of Invasive Pulmonary Aspergillosis in Liver Transplant Recipients. J Thorac Imaging 2012; 27:107-12. [DOI: 10.1097/rti.0b013e31820bb462] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Emergency versus elective living-donor liver transplantation: a comparison of a single center analysis. Surg Today 2011; 42:453-9. [PMID: 22116395 PMCID: PMC7101615 DOI: 10.1007/s00595-011-0040-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2011] [Accepted: 04/26/2011] [Indexed: 11/20/2022]
Abstract
Purpose We studied the risk factors for postoperative mortality between patients who underwent emergency or elective living-donor liver transplantation (LDLT). Methods Forty-seven patients underwent LDLT in our institute, 16 for emergencies and 31 as elective procedures. The emergency LDLT status was applied to cases in which the time period between referral to our institution and transplantation did not exceed 10 days, and in which liver failure was accompanied by the presence of any degree of hepatic encephalopathy. Results With regard to preoperative factors, age (P = 0.03), the model for end-stage liver disease score (P = 0.001), preoperative tracheal intubation (P = 0.001), ratio between arterial oxygen tension and fractional inspired oxygen (PaO2/FiO2 ratio) (P = 0.03), steroid therapy use (P = 0.001), lymphocyte count (P = 0.02), and cases requiring hemodiafiltration (P = 0.001) differed significantly between the two groups. Postoperative pneumonia occurred more frequently in emergency LDLT patients than in elective LDLT patients (P = 0.006). Invasive pulmonary aspergillosis (IPA) was the main cause of postoperative death in emergency LDLT patients, and, in a univariate analysis, a preoperative status of high serum (1 → 3)-β-d-glucan (>20 pg/ml, P = 0.001), advanced age (>52 years, P = 0.02), and a low PaO2/FiO2 ratio (<320, P = 0.01) were identified as factors predictive of IPA. Conclusion Careful perioperative management, including preoperative investigation of aspergillosis and empiric antibiotic therapy, should be considered for emergency LDLT patients who fulfill IPA risk factors.
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Takeda K, Morioka D, Kumamoto T, Matsuo K, Tanaka K, Endo I, Togo S, Shimada H. A survival case of ABO-incompatible liver transplantation complicated with severe preoperative infection and subsequent overwhelming postsplenectomy infection. Transplant Proc 2010; 41:3941-4. [PMID: 19917418 DOI: 10.1016/j.transproceed.2009.02.094] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2008] [Accepted: 02/23/2009] [Indexed: 11/28/2022]
Abstract
A 47-year-old Japanese man was transferred to our hospital because of acute-on-chronic hepatitis B virus infection. On admission, he was suffering from sepsis due to a catheter infection and respiratory failure caused by pulmonary edema and pneumonia, but, as a result of preoperative intensive care, we avoided septic shock. ABO-incompatible liver transplantation (ABO-I-LT) was performed. In accordance with our ABO-I-LT protocol, we administered, rituximab and performed plasma exchange, splenectomy as well as hepatic artery infusion. The patient was discharged 80 days after living donor transplantation (LDLT). However, 136 days after LDLT, he experienced recurrent respiratory failure due to severe pneumonia. At that time, the CD19(+) B-cell count in the peripheral blood flow remained below 1%. We suspected a mixed infection involving Streptococcus pneumonia, Pneumocystis carinii, and fungus. The cause of the complication was overwhelming postsplenectomy infection (OPSI). We started administration of sulfamethoxazole and trimethoprim, ciprofloxacin hydrochloride, and micafungin sodium therapy as well as gamma-globulin. Oxygenation improved gradually; the patient was discharged at 41 days after re-admission. Although this patient survived the OPSI, it was clear that some aspects of the ABO-I-LT protocol should also be altered.
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Affiliation(s)
- K Takeda
- Department of Gastroenterological Surgery, Yokohama City University, Yokohama, Japan
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Kim JM, Kwon CHD, Joh JW, Song S, Shin M, Kim SJ, Hong SH, Kim BN, Lee SK. Aspergillosis in Liver Transplant Recipients: A Single Center Experience. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2010. [DOI: 10.4174/jkss.2010.79.4.267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Organ Transplant Center, Seoul, Korea
| | - Choon Hyuck David Kwon
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Organ Transplant Center, Seoul, Korea
| | - Jae-Won Joh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Organ Transplant Center, Seoul, Korea
| | - Sanghyun Song
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Organ Transplant Center, Seoul, Korea
| | - Milljae Shin
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Organ Transplant Center, Seoul, Korea
| | - Sung Joo Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Organ Transplant Center, Seoul, Korea
| | - Seung Heui Hong
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Organ Transplant Center, Seoul, Korea
| | - Bok Nyeo Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Organ Transplant Center, Seoul, Korea
| | - Suk-Koo Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Organ Transplant Center, Seoul, Korea
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Salavert-Lletí M, Zaragoza-Crespo R. [Future role of micafungin in the treatment of invasive mycoses caused by filamentous fungi]. Rev Iberoam Micol 2009; 26:81-9. [PMID: 19463284 DOI: 10.1016/s1130-1406(09)70015-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Accepted: 02/17/2009] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Micafungin is a echinocandin. It inhibits beta-1,3-D-glucan synthesis, thus achieving fungicidal activity against virtually all Candida spp., including those resistant to fluconazole, and fungistatic activity against Aspergillus spp., as well as several but not all pathogenic molds. Results from in vitro studies, animal models, small clinical trials, hint at possible future indications such as invasive aspergillosis and empirical viantifungal therapy, although currently there is little information published. AIMS To describe published data of micafungin as treatment against invasive mold infections, specially analysing its role in the inmunodepressed host and critical care setting. METHODS A systematic review of literature using the principal medical search engines was performed. Terms such as micafungin, aspergillosis, zygomycosis, invasive fungal infections, emerging fungal infections, antifungal treatment or therapy, antifungal prophylaxis, empiric or pre-emptive therapy were crossed. Febrile neutropenia patients were excluded. RESULTS Several studies in these setting were identified and were described in this review. Although there were no blinded randomized clinical trials published, treatment or prophylaxis of invasive aspergillosis and other invasive mould infections with micafungin described in open clinical studies were analyzed. CONCLUSIONS Micafungin could play a future important role as a primary or rescue therapy, alone or in combination, in the treatment or prophylaxis of invasive fungal infections caused by moulds. New randomized clinical trials are needed to confirm their efficacy.
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Current world literature. Curr Opin Organ Transplant 2009; 14:211-7. [PMID: 19307967 DOI: 10.1097/mot.0b013e32832ad721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Muraki Y, Iwamoto T, Kagawa Y, Sakurai H, Usui M, Isaji S, Uemoto S, Okuda M. The Impact of Total Bilirubin on Plasma Micafungin Levels in Living-Donor Liver Transplantation Recipients with Severe Liver Dysfunction. Biol Pharm Bull 2009; 32:750-4. [DOI: 10.1248/bpb.32.750] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Yuichi Muraki
- Department of Pharmacy, Mie University Hospital, Faculty of Medicine, Mie University
| | - Takuya Iwamoto
- Department of Pharmacy, Mie University Hospital, Faculty of Medicine, Mie University
| | - Yoshiyuki Kagawa
- Department of Pharmacy, Mie University Hospital, Faculty of Medicine, Mie University
- Department of Clinical Pharmaceutics and Pharmacy Practice, School of Pharmaceutical Sciences University of Shizuoka
| | - Hiroyuki Sakurai
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine
| | - Masanobu Usui
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine
| | - Shuji Isaji
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine
| | - Shinji Uemoto
- Department of Transplantation and Immunology, Kyoto University Graduate School of Medicine
| | - Masahiro Okuda
- Department of Pharmacy, Mie University Hospital, Faculty of Medicine, Mie University
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