Comparison of the efficacy of combination and monotherapy with caspofungin and liposomal amphotericin B against invasive candidiasis. 2008

Ozlem Tunger, and Halim Bayram, and Kenan Degerli, and Gonul Dinc, and Banu C Cetin
Department of Infectious Diseases, Celal Bayar University, Faculty of Medicine, Manisa, Turkey. otunger@hotmail.com

OBJECTIVE To investigate if combination therapy with liposomal amphotericin B (LAmB), and caspofungin (CAS) is superior to monotherapies in an experimental model with azole-resistant Candida albicans. METHODS This study was carried out between October 2006 and August 2007 in Celal Bayar University, Manisa, Turkey. A total of 144 mice were included in the study, and divided into 4 groups as: control (n=36), CAS treatment group n=36, LAmB treatment group (n=36), and combination therapy group (n=36). Treatment efficacy was assessed by determining survival, as well as, the decrease in tissue fungal densities. RESULTS The fungal densities in tissues were significantly reduced, and the survival rates were prolonged with either CAS only, or LAmB only, or with combination therapy compared to those of controls (p<0.05). There was no significant difference between monotherapy groups. Decrease in tissue fungal densities were significant in CAS and LAmB (1mg/kg) combination group, compared to CAS (1mg/kg) and LAmB (1mg/kg) groups (p=0.004 for CAS, p=0.009 for LAmB). Survival rates were similar in both treatment groups. CONCLUSIONS The combination treatment was superior with 1mg/kg of doses of LAmB and CAS in terms of reducing the tissue fungal burden. Although with combination therapy the survival rates prolonged in all subgroups, no significant difference between the combination and monotherapies could be shown. Additional studies with a large number of cases are warranted to investigate the superiority of combination therapy.

UI MeSH Term Description Entries
D002177 Candidiasis Infection with a fungus of the genus CANDIDA. It is usually a superficial infection of the moist areas of the body and is generally caused by CANDIDA ALBICANS. (Dorland, 27th ed) Candida Infection,Moniliasis,Candida Infections,Candidiases,Infection, Candida,Moniliases
D004359 Drug Therapy, Combination Therapy with two or more separate preparations given for a combined effect. Combination Chemotherapy,Polychemotherapy,Chemotherapy, Combination,Combination Drug Therapy,Drug Polytherapy,Therapy, Combination Drug,Chemotherapies, Combination,Combination Chemotherapies,Combination Drug Therapies,Drug Polytherapies,Drug Therapies, Combination,Polychemotherapies,Polytherapies, Drug,Polytherapy, Drug,Therapies, Combination Drug
D000077336 Caspofungin A cyclic lipopeptide echinocandin and beta-(1,3)-D-glucan synthase inhibitor that is used to treat internal or systemic MYCOSES. Cancidas,Caspofungin Acetate,Caspofungin MSD,L 743,872,L 743872,L-743,872,L-743872,MK 0991,MK-0991,L743,872,L743872,MK0991
D000666 Amphotericin B Macrolide antifungal antibiotic produced by Streptomyces nodosus obtained from soil of the Orinoco river region of Venezuela. Amphocil,Amphotericin,Amphotericin B Cholesterol Dispersion,Amphotericin B Colloidal Dispersion,Fungizone
D000818 Animals Unicellular or multicellular, heterotrophic organisms, that have sensation and the power of voluntary movement. Under the older five kingdom paradigm, Animalia was one of the kingdoms. Under the modern three domain model, Animalia represents one of the many groups in the domain EUKARYOTA. Animal,Metazoa,Animalia
D015996 Survival Rate The proportion of survivors in a group, e.g., of patients, studied and followed over a period, or the proportion of persons in a specified group alive at the beginning of a time interval who survive to the end of the interval. It is often studied using life table methods. Cumulative Survival Rate,Mean Survival Time,Cumulative Survival Rates,Mean Survival Times,Rate, Cumulative Survival,Rate, Survival,Rates, Cumulative Survival,Rates, Survival,Survival Rate, Cumulative,Survival Rates,Survival Rates, Cumulative,Survival Time, Mean,Survival Times, Mean,Time, Mean Survival,Times, Mean Survival
D051379 Mice The common name for the genus Mus. Mice, House,Mus,Mus musculus,Mice, Laboratory,Mouse,Mouse, House,Mouse, Laboratory,Mouse, Swiss,Mus domesticus,Mus musculus domesticus,Swiss Mice,House Mice,House Mouse,Laboratory Mice,Laboratory Mouse,Mice, Swiss,Swiss Mouse,domesticus, Mus musculus
D054714 Echinocandins Cyclic hexapeptides of proline-ornithine-threonine-proline-threonine-serine. The cyclization with a single non-peptide bond can lead them to be incorrectly called DEPSIPEPTIDES, but the echinocandins lack ester links. Antifungal activity is via inhibition of 1,3-beta-glucan synthase production of BETA-GLUCANS. Aculeacin,Echinocandin,Pneumocandin,Aculeacins,Mulundocandins,Pneumocandins
D055666 Lipopeptides Compounds consisting of a short peptide chain conjugated with an acyl chain. Lipopeptide,Anionic Lipopeptide,Anionic Lipopeptides,Cationic Lipopeptide,Cationic Lipopeptides,Lipopeptide, Anionic,Lipopeptide, Cationic,Lipopeptides, Anionic,Lipopeptides, Cationic
D018709 Statistics, Nonparametric A class of statistical methods applicable to a large set of probability distributions used to test for correlation, location, independence, etc. In most nonparametric statistical tests, the original scores or observations are replaced by another variable containing less information. An important class of nonparametric tests employs the ordinal properties of the data. Another class of tests uses information about whether an observation is above or below some fixed value such as the median, and a third class is based on the frequency of the occurrence of runs in the data. (From McGraw-Hill Dictionary of Scientific and Technical Terms, 4th ed, p1284; Corsini, Concise Encyclopedia of Psychology, 1987, p764-5) Kolmogorov-Smirnov Test,Kruskal-Wallis H Statistic,Mann-Whitney U Test,Rank-Sum Tests,Spearman Rank Correlation Coefficient,Wilcox Test,Wilcoxon Rank Test,Non-Parametric Statistics,Nonparametric Statistics,Statistics, Non-Parametric,Kolmogorov Smirnov Test,Mann Whitney U Test,Non Parametric Statistics,Rank Sum Tests,Rank Test, Wilcoxon,Rank-Sum Test,Statistics, Non Parametric,Test, Kolmogorov-Smirnov,Test, Mann-Whitney U,Test, Rank-Sum,Test, Wilcox,Test, Wilcoxon Rank,Tests, Rank-Sum,U Test, Mann-Whitney

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