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Clinical pharmacodynamic index identification for micafungin in esophageal candidiasis: dosing strategy optimization.

Author(s): Andes DR(1), Reynolds DK, Van Wart SA, Lepak AJ, Kovanda LL, Bhavnani SM.

Affiliation(s): Author information: (1)Department of Medicine, University of Wisconsin, Madison, Wisconsin, USA.

Publication date & source: 2013, Antimicrob Agents Chemother. , 57(11):5714-6

Echinocandins exhibit concentration-dependent effects on Candida species, and preclinical studies support the administration of large, infrequent doses. The current report examines the pharmacokinetics/pharmacodynamics of two multicenter, randomized trials of micafungin dosing regimens that differed in both dose level and dosing interval. Analysis demonstrates the clinical relevance of the dose level and area under the concentration-time curve (AUC). Better, although not statistically significant (P = 0.056), outcomes were seen with higher maximum concentrations of drug in serum (Cmax) and large, infrequent doses. The results support further clinical investigation of novel micafungin dosing regimens with large doses but less than daily administration. (These studies have been registered at ClinicalTrials.gov under registration no. NCT00666185 and NCT00665639.).

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