Caspofungin Use and Dosing in Critical Care Settings
Caspofungin should be administered as a 70-mg loading dose on Day 1, followed by 50 mg once daily for treating severe fungal infections in critical care settings. 1
Administration Instructions
- Administer caspofungin by slow intravenous (IV) infusion over approximately 1 hour 1
- Never administer caspofungin as an IV bolus 1
Dosing Recommendations for Adults (≥18 years)
Empirical Therapy for Presumed Fungal Infections in Febrile Neutropenic Patients
- Initial dose: 70-mg loading dose on Day 1 1
- Maintenance dose: 50 mg once daily thereafter 1
- Duration: Continue until resolution of neutropenia 1
- For patients with documented fungal infection: Minimum 14 days after the last positive culture and at least 7 days after both neutropenia and clinical symptoms resolve 1
- If clinical response is inadequate with 50 mg daily, dose can be increased to 70 mg daily 1
Candidemia and Other Candida Infections
- Initial dose: 70-mg loading dose on Day 1 1
- Maintenance dose: 50 mg once daily thereafter 1
- Duration: At least 14 days after the last positive culture 1
- For neutropenic patients: Consider longer treatment until neutropenia resolves 1
Invasive Aspergillosis
- Initial dose: 70-mg loading dose on Day 1 1
- Maintenance dose: 50 mg once daily thereafter 1
- Duration: Based on disease severity, immune recovery, and clinical response 1
Dosing in Special Populations
Pediatric Patients (3 months to 17 years)
- Initial dose: 70 mg/m² loading dose on Day 1 (maximum 70 mg) 1
- Maintenance dose: 50 mg/m² once daily (maximum 70 mg) 1
- Calculate BSA using the Mosteller Formula 1
- If clinical response is inadequate, dose can be increased to 70 mg/m² daily (not exceeding 70 mg) 1
Patients with Hepatic Impairment
- Mild impairment (Child-Pugh score 5-6): No dosage adjustment needed 1
- Moderate impairment (Child-Pugh score 7-9): 35 mg once daily with a 70-mg loading dose on Day 1 1
- Severe impairment (Child-Pugh score >9): No clinical experience in adults or any pediatric patients with hepatic impairment 1
Clinical Pearls for Critical Care Settings
- Monitor for clinical response and consider dose escalation to 70 mg daily if response is inadequate 1
- For patients with persistent neutropenia, longer treatment courses may be necessary 1
- Caspofungin does not require dose adjustment based on renal function 1
- Always consider the underlying disease severity and immune status when determining treatment duration 1