Table 1 Randomized multicentre clinical trials of antifungal therapy in patients with candidaemia or invasive candidiasis
From: Bench-to-bedside review: Candida infections in the intensive care unit
| Â | Pappas et al. [30] | Mora-Duarte et al. [32] | Kuse et al. [34] | Reboli et al. [35] | Kullberg et al. [33] | Rex et al. [31] | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Â | Micafungin | Micafungin | Caspofungin | Caspofungin | Amphotericin B deoxycholate | Micafungin | Liposomal amphotericin B | Anidulafungin | Fluconazole | Voriconazole | Amphotericin B deoxycholate followed by fluconazole | Fluconazole | Amphotericin B deoxycholate |
Daily dose | 100 mga | 150 mga | 70 mg load, followed by 50 mga | 70 mg load, followed by 50 mga | 0.6 to 0.7 mg/kga | 100 mg | 3 mg/kg | 200 mg load, followed by 100 mga | 800 mg load, followed by 400 mga | 6 mg/kg twice daily day 1, followed by 3 mg/kg twice daily | 0.7 to 1 mg/kg, day 3 to 7 iv/oral. Fluconazole 400 mg | 400 mgb | 0.5 to0.6 mg/kg |
Number of patients | 191 | 199 | 188 | 114 | 125 | 264 | 267 | 132 | 129 | 272 | 131 | 113 | 111 |
Mean APACHE II score | 14.9 | 14.7 | 13.8 | 14.8 | 15.4 | 15.8 | 15.6 | 15.0 | 14.4 | 13.8 | 14.7 | 16 | 16 |
Neutrophil count <500/mm3 | 11.5% | 8.5% | 5.9% | 12.8% | 8.7% | 13% | 10% | 2% | 3% | Exclusion criterion | Exclusion criterion | Exclusion criterion | Exclusion criterion |
Candida spp. | |||||||||||||
   C. albicans | 48.2% | 51.3% | 44.1% | 35.6% | 54.1% | 42% | 44% | 64% | 59% | 43% | 21% | 68% | 61% |
   Non-albicans | 54.5% | 51.3% | 60.6% | 64.4% | 45.9% | 62% | 59% | 43% | 50% | 61% | 50% | 32% | 39% |
C. glabrata | 14.7% | 17.1% | 17.6% | 12.8% | 9.2% | 11% | 7.4% | 16% | 25% | 15% | 17% | 12.6% | 10.6% |
C. krusei | 4.2% | 4.0% | 2.1% | 4% | 0.9% | 3% | 3.5% | NR | NR | 2% | 1% | 1.9% | 1% |
Site of infection | |||||||||||||
   Blood only | 85.3% | 84.4% | 85.6% | 82.6% | 79.1% | 84% | 86% | 91% | 87% | 96% | 96% | 70% | 74% |
   Blood and other site | NR | NR | NR | 4.6% | 3.5% | NR | NR | 3% | 3% | 4% | 4% | 30% | 26% |
   Other site only | 14.7% | 15.1% | 13.8% | 12.8% | 17.4% | 16% | 14% | 6% | 9% | NR | NR | NR | NR |
Days of therapy | 14 (median) | 14(median) | 14 (median) | 12.1 (mean) | 11.7 (mean) | 15 (median) | 15 (median) | 15.9 (mean) | 14.4 (mean) | 15 (median) | 15 (median) | 18 (mean) | 17 (mean) |
Success of therapyc | |||||||||||||
   At end of iv therapy | 76.4% | 71.4% | 72.3% | 73.4% | 61.7% | 74.1% | 69.6% | 75.6% | 60.2% | 70% | 74% | 74% | 83% |
   C. glabrata infectiond | 85.7% | 88.2% | 66.7% | 76.9% | 80% | 82.6%e | 80.0%e | 75% | 60% | 33%f | 33%f | NR | NR |
   Neutropeniad | 81.8% | 52.9% | 63.6% | 50% | 40% | 59.4% | 56.0% | NR | NR | NR | NR | NR | NR |
Drug-related toxicityg | |||||||||||||
   Adverse eventsh | 22% | 22.8% | 23.8% | 42.1% | 75.2% | 43.2% | 50.9% | 24.4%i | 26.4%i | 46% | 57% | NR | NR |
   Therapy discontinuation | 2.5% | 3.0% | 3.6% | 2.6% | 23.2% | 4.9% | 9.0% | NR | NR | 6% | 5% | 2.9%i | 3.8%i |