Recommended Dosage and Treatment Duration of Caspofungin for Invasive Candidiasis
For invasive candidiasis including candidemia, caspofungin should be administered as a 70 mg loading dose on day 1, followed by 50 mg daily maintenance dose, with treatment continuing for at least 2 weeks after documented clearance of Candida from the bloodstream and resolution of symptoms attributable to candidemia. 1
Dosing Recommendations
Adult Patients:
- Initial loading dose: 70 mg intravenously on day 1 1, 2
- Maintenance dose: 50 mg intravenously daily 1, 2
- Higher doses of 150 mg daily have been studied and appear safe but do not offer significant additional efficacy benefits 3
Special Populations:
- Patients with moderate hepatic insufficiency (Child-Pugh score 7-9) should receive a reduced maintenance dose 4
- No dose adjustment is required based on age, sex, race, or renal function 4
Treatment Duration
- For candidemia without metastatic complications: Minimum of 2 weeks after documented clearance of Candida from the bloodstream AND resolution of symptoms attributable to candidemia 1
- For chronic disseminated (hepatosplenic) candidiasis: Several weeks of initial therapy with caspofungin, followed by oral fluconazole 400 mg (6 mg/kg) daily until lesions resolve on repeat imaging, which typically takes several months 1
- For empiric therapy of suspected invasive candidiasis in patients who improve: 2 weeks, the same as for documented candidemia 1
- For patients without clinical response to empiric therapy after 4-5 days and no subsequent evidence of invasive candidiasis: Consider stopping antifungal therapy 1
Efficacy Data
- Caspofungin has demonstrated efficacy comparable to amphotericin B deoxycholate for invasive candidiasis, with better tolerability 1, 2
- Overall success rates for various forms of invasive candidiasis with caspofungin therapy:
Clinical Considerations
- Echinocandins (including caspofungin) are recommended as first-line therapy for invasive candidiasis due to their fungicidal activity against most Candida species 1
- Central venous catheters should be removed as early as possible in the course of candidemia when the source is presumed to be the catheter 1
- For neutropenic patients with candidemia, caspofungin is strongly recommended as initial therapy 1
- Testing for azole susceptibility is recommended for all bloodstream and other clinically relevant Candida isolates 1
- For infections due to C. krusei, an echinocandin such as caspofungin is specifically recommended 1
Pediatric Considerations
- Caspofungin has been studied in pediatric patients with invasive candidiasis at a dose of 70 mg/m² on day 1, followed by 50 mg/m² daily (maximum: 70 mg/day) 6
- In neonates, echinocandins should be used with caution and generally limited to salvage therapy 1
Safety Profile
- Caspofungin is generally well-tolerated with few serious adverse events 5, 3
- Common drug-related adverse events include phlebitis, increased alkaline phosphatase, and increased aspartate transaminase levels 3
- No significant differences in mortality, relapsing infections, or adverse events between standard dose (50 mg daily) and high-dose (150 mg daily) regimens 3
Remember that treatment decisions should be guided by patient-specific factors including severity of illness, prior antifungal exposure, and local epidemiology of Candida species and their susceptibility patterns 1.