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A
Randomized Double-Blind Study of Caspofungin versus Amphotericin
for the Treatment of Candida Esophagitis [Villanueva A et al.
CID 2001;33:1529] The authors report the results of a multicenter,
double-blind, randomized trial comparing caspofungin (50-70 mg/day)
vs. amphotericin B (0.5 mg/kg/day). Outcome was evaluated by endoscopy
in 14 days. The outcome was endoscopic plus clinical success in
74% for those receiving 50 mg/day of caspofungin, and it was 89%
for those receiving 70 mg/day. By comparison it was 63% for those
given amphotericin B. Therapy was stopped due to adverse events
ascribed to the drug in 4%, 7%, and 24% of these three groups, respectively.
The authors conclude that caspofungin appears to be as effective
as amphotericin, and is better tolerated than that drug in the treatment
of esophageal candidiasis.
Comment: The authors claim that this is the first comparative
trial of caspofungin vs. amphotericin in the treatment of human
fungal infection. The median time to symptom resolution was four
days for all three treatment groups. The main advantage of caspofungin
was that it was better tolerated. The authors conclude that this
drug may be particularly attractive for patients with renal failure.
posted
11/19/2001
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