Vol.54 No.2 March 2006

The efficacy of Micafungin as an empiric therapy for febrile neutropenic patients refractory to antibacterial agents

Takahiko Ishikawa¹⁾, Tohru Takata¹⁾, Takeaki Tomoyose²⁾, Masato Masuda²⁾, Sawako Nakachi²⁾, Shin Koga³⁾, Junichi Tsukada⁴⁾, Ai Matsuura⁴⁾, Atae Utsunomiya⁵⁾, Yoshio Saburi⁶⁾ and Kazuo Tamura¹⁾

¹⁾First Department of Internal Medicine, Fukuoka University School of Medicine,
7-45-1 Nanakuma, Jonan-ku, Fukuoka, Japan
²⁾Second Department of Internal Medicine, Ryukyu University School of Medicine
³⁾Department of Internal Medicine, Amakusa Chuo General Hospital
(University of Shizuoka, Junior College, Department of Nursing Section of Hematology and Oncology)
⁴⁾First Department of Internal Medicine, University of Occupational and Environmental Health
⁵⁾Department of Internal Medicine, Imamura Bun-in Hospital
⁶⁾Department of Internal Medicine, Oita Prefectural Hospital

Abstract

We evaluated the efficacy and safety of Micafungin (MCFG) as an empiric therapy for febrile neutropenic patients refractory to antibacterial agents. MCFG was administered to patients with either adult hematopoietic disease or solid tumors refractory to anti-microbial agents which are known to be effective for Pseudomonas aeruginosa after performing appropriate laboratory tests and imaging studies. The MCFG dosages ranged from 50 mg to 150 mg once daily, including 300 mg once daily if judged to be necessary by the doctor. MCFG was administered for at least seven days unless any adverse events were observed. The clinical efficacy of MCFG was determined by the doctor based on the general status and from the results of imaging and laboratory tests for each patient. This study was carried out prospectively by the Kyushu Hematology Organization for Treatment (K-HOT) Study Group as a multicentric trial for two years from April 2003. Thirteen cases were analysed (4 males and 9 females) consisting of 12 cases with hematopoietic disease and one case with breast cancer. The patients were classified according to the number of neutrophils that they demonstrated, namely, 6 cases<100/μL, 4 cases 100/μL∼500/μL and 3 cases>1,000/μL, respectively. Efficacy was observed in 11 cases (85%) and the regimen was ineffective in 2 cases (15%). In one of the ineffective cases, MCFG was continued and judged to be effective on the fourteenth day. In the other ineffective case, however, MCFG was discontinued on the seventh day due to liver damage. No fatality occurred during the administration of MCFG, suggesting that MCFG is a safe and effective antifungal agent for patients with febrile neutropenia refractory to antibacterial agents.

Key word

febrile neutropenia, micafungin, empiric therapy

Received

November 5, 2005

Accepted

January 30, 2006

Jpn. J. Chemother. 54 (2): 125-128, 2006