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Antimicrobial Agents and Chemotherapy, March 2007, p. 968-974, Vol. 51, No. 3
0066-4804/07/$08.00+0     doi:10.1128/AAC.01337-06
Copyright © 2007, American Society for Microbiology. All Rights Reserved.

Once-Weekly Micafungin Therapy Is as Effective as Daily Therapy for Disseminated Candidiasis in Mice with Persistent Neutropenia{triangledown}

Tawanda Gumbo,1,2* George L. Drusano,1 Weiguo Liu,1 Robert W. Kulawy,1 Christine Fregeau,1 Vasha Hsu,1 and Arnold Louie1

Emerging Infections and Host Defenses Section, Ordway Research Institute, 150 New Scotland Avenue, Albany, New York,1 University of Texas Southwestern Medical Center, Dallas, Texas2

Received 25 October 2006/ Returned for modification 21 November 2006/ Accepted 18 December 2006

The effect of micafungin dose scheduling on the treatment of candidemia is unknown. Neutropenic mice with disseminated Candida glabrata infection were treated with single intraperitoneal micafungin doses of 0 to 100 mg/kg of body weight and sacrificed 7 days later. The maximal decline in kidney fungal burden was 5.8 log10 CFU/g. A 1-week pharmacokinetic-pharmacodynamic study revealed a micafungin serum half-life of 6.13 h. In mice treated with ≥50 mg/kg, there was maximal fungal decline without regrowth during the 1-week dosing interval. Next, doses associated with 34% (34% effective dose [ED34]) and 50% (ED50) of maximal kill were administered at one of three dose schedules: a single dose at t = 0, two equal doses at t = 0 and t = 3.5 days, and 7 equal doses daily. Some mice received a single dose of 100 mg/kg. Fungal burden was examined on days 1, 5, and 7. In mice treated with the ED34, microbial kill with the daily therapy initially lagged behind the intermittent doses but exceeded it by day 7. In mice treated with the ED50, daily and intermittent doses had equivalent day 7 effects. In mice treated with 100 mg/kg, there was no regrowth. The relative likelihoods that the area under the concentration-time curve/MIC ratio was linked to microbial kill versus peak concentration/MIC ratio or time above the MIC was 10.3 and 10,161.2, respectively. In all the experiments, no paradoxical increase in fungal burden was observed with high micafungin doses. However, only a single Candida isolate was tested. Regimens that simulated micafungin concentration-time profiles in patients treated with a single micafungin dose of 1,400 mg once a week demonstrated maximal fungal decline. Once-weekly micafungin therapy is as efficacious as daily therapy in a murine model of disseminated candidiasis.

* Corresponding author. Mailing address: Division of Infectious Diseases, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9113. Phone: (214) 648-9914. Fax: (214) 648-2741. E-mail: Tawanda.Gumbo{at}UTSouthwestern.edu.

{triangledown} Published ahead of print on 28 December 2006.

Antimicrobial Agents and Chemotherapy, March 2007, p. 968-974, Vol. 51, No. 3
0066-4804/07/$08.00+0     doi:10.1128/AAC.01337-06
Copyright © 2007, American Society for Microbiology. All Rights Reserved.



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