From the Research
The optimal duration of caspofungin therapy for Candida auris bloodstream infections is typically 14 days after the first negative blood culture, with a minimum total treatment course of 14-21 days. Caspofungin is administered intravenously at a loading dose of 70 mg on day 1, followed by 50 mg daily (dose reduction to 35 mg daily may be needed in moderate hepatic insufficiency) 1. Treatment should continue until blood cultures remain negative for at least 14 days, clearance of the source of infection is achieved, and clinical improvement is observed. Source control through removal of infected catheters or drainage of abscesses is essential for successful treatment. Daily blood cultures should be obtained until clearance of candidemia is documented. Caspofungin is often preferred for C. auris infections due to high rates of fluconazole resistance in this species, though susceptibility testing is crucial as echinocandin resistance can develop during treatment 2. In cases of persistent candidemia or clinical deterioration, combination therapy or alternative agents may be considered based on susceptibility patterns.
Some key points to consider when treating Candida auris bloodstream infections with caspofungin include:
- The importance of susceptibility testing to guide treatment decisions 2
- The need for source control and removal of infected catheters or drainage of abscesses 1
- The potential for echinocandin resistance to develop during treatment 2
- The consideration of combination therapy or alternative agents in cases of persistent candidemia or clinical deterioration 3
It's worth noting that while there are several studies that discuss the use of caspofungin in treating Candida infections, the most recent and highest quality study that specifically addresses the duration of caspofungin therapy for Candida auris bloodstream infections is not explicitly stated in the provided evidence. However, based on the available evidence, the recommended treatment duration of 14-21 days appears to be a reasonable approach 1, 3.