Griseofulvin p. 379 is effective for widespread or intractable
dermatophyte infections but has been superseded by newer
antifungals, particularly for nail infections. Griseofulvin is
used in the treatment of tinea capitis. It is the drug of choice
for trichophyton infections in children. Duration of therapy
is dependent on the site of the infection and may extend to a
number of months.
Terbinafine p. 726 is the drug of choice for fungal nail
infections and is also used for ringworm infections where
oral treatment is considered appropriate.ANTIFUNGALS›ECHINOCANDIN ANTIFUNGALS
Caspofungin
lINDICATIONS AND DOSE
Invasive aspergillosis|Invasive candidiasis|Empirical
treatment of systemic fungal infections in patients with
neutropenia
▶BY INTRAVENOUS INFUSION
▶Neonate: 25 mg/m^2 once daily.▶Child 1–2 months: 25 mg/m^2 once daily
▶Child 3–11 months: 50 mg/m^2 once daily
▶Child 1–17 years: 70 mg/m^2 once daily (max. per dose
70 mg) for 1 day, then 50 mg/m^2 once daily (max. per
dose 70 mg); increased to 70 mg/m^2 once daily (max.
per dose 70 mg), dose may be increased if lower dose
tolerated but inadequate response
DOSE ADJUSTMENTS DUE TO INTERACTIONS
▶Manufacturer advises increase dose to 70 mg/m^2 daily
(max. 70 mg daily) with concurrent use of some enzyme
inducers (such as carbamazepine, dexamethasone,
phenytoin, and rifampicin).lINTERACTIONS→Appendix 1 : caspofungin
lSIDE-EFFECTS
▶Common or very commonArthralgia.diarrhoea.dyspnoea.
electrolyte imbalance.fever.headache.hyperhidrosis.
nausea.skin reactions.vomiting
▶UncommonAnaemia.anxiety.appetite decreased.
arrhythmias.ascites.chest discomfort.coagulation
disorder.congestive heart failure.constipation.cough.
disorientation.dizziness.drowsiness.dry mouth.
dysphagia.excessive tearing.eyelid oedema.fatigue.
flatulence.fluid overload.flushing.gastrointestinal
discomfort.haematuria.hepatic disorders.
hyperbilirubinaemia.hyperglycaemia.hypertension.
hypotension.hypoxia.insomnia.laryngeal pain.
leucopenia.malaise.metabolic acidosis.muscle weakness
.myalgia.nasal congestion.oedema.pain.palpitations.
renal impairment.respiratory disorders.sensation
abnormal.taste altered.thrombocytopenia.tremor.
vision blurred
▶Frequency not knownSevere cutaneous adverse reactions
(SCARs)
lPREGNANCYManufacturer advises avoid unless
essential—toxicity inanimalstudies.
lBREAST FEEDINGPresent in milk inanimalstudies—
manufacturer advises avoid.
lHEPATIC IMPAIRMENTNo information available for severe
impairment.
Dose adjustmentsUsual initial dose, then use 70 %of
normal maintenance dose in moderate impairment.
lDIRECTIONS FOR ADMINISTRATIONForintravenous infusion
(Cancidas®), allow vial to reach room temperature;
initially reconstitute 50 mg with 10. 5 mL Water for
Injections to produce a 5. 2 mg/mL solution, or reconstitute
70 mg with 10. 5 mL Water for Injections to produce a
7. 2 mg/mL solution; mix gently to dissolve; dilute requisite
dose to afinal concentration not exceeding500 micrograms/mL with Sodium Chloride 0. 9 %; give over
60 minutes; incompatible with glucose solutions.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Powder for solution for infusion
▶Caspofungin (Non-proprietary)
Caspofungin (as Caspofungin acetate) 50 mgCaspofungin 50 mg
powder for concentrate for solution for infusion vials| 1 vialP
£ 81. 92 – £ 327. 67
Caspofungin (as Caspofungin acetate) 70 mgCaspofungin 70 mg
powder for concentrate for solution for infusion vials| 1 vialP
£ 104. 20 – £ 416. 78
▶Cancidas(Merck Sharp & Dohme Ltd)
Caspofungin (as Caspofungin acetate) 50 mgCancidas 50 mg
powder for solution for infusion vials| 1 vialP£ 327. 67
Caspofungin (as Caspofungin acetate) 70 mgCancidas 70 mg
powder for solution for infusion vials| 1 vialP£ 416. 78Micafungin
lINDICATIONS AND DOSE
Invasive candidiasis
▶BY INTRAVENOUS INFUSION
▶Neonate (administered on expert advice): 2 mg/kg once
daily for at least 14 days; increased if necessary to
4 mg/kg once daily, increase dose if response
inadequate.▶Child (body-weight up to 40 kg): 2 mg/kg once daily for at
least 14 days; increased if necessary to 4 mg/kg once
daily, increase dose if response inadequate
▶Child (body-weight 40 kg and above): 100 mg once daily
for at least 14 days; increased if necessary to 200 mg
once daily, increase dose if response inadequate
Oesophageal candidiasis
▶BY INTRAVENOUS INFUSION
▶Child 16–17 years (body-weight up to 40 kg): 3 mg/kg once
daily
▶Child 16–17 years (body-weight 40 kg and above): 150 mg
once daily
Prophylaxis of candidiasis in patients undergoing bone-
marrow transplantation or who are expected to become
neutropenic for over 10 days
▶BY INTRAVENOUS INFUSION
▶Neonate: 1 mg/kg once daily continue for at least 7 days
after neutrophil count is in desirable range.▶Child (body-weight up to 40 kg): 1 mg/kg once daily
continue for at least 7 days after neutrophil count is in
desirable range
▶Child (body-weight 40 kg and above): 50 mg once daily
continue for at least^7 days after neutrophil count is in
desirable rangelINTERACTIONS→Appendix 1 : micafungin
lSIDE-EFFECTSAnaemia.anxiety.appetite decreased.
arrhythmias.confusion.constipation.diarrhoea.
disseminated intravascular coagulation.dizziness.
drowsiness.dyspnoea.electrolyte imbalance.
eosinophilia.flushing.gastrointestinal discomfort.
haemolysis.haemolytic anaemia.headache.hepatic
disorders.hepatic failure (potentially life-threatening).
hyperbilirubinaemia.hyperhidrosis.hypersensitivity.
hypertension.hypoalbuminaemia.hypotension.
insomnia.leucopenia.nausea.neutropenia.palpitations
.pancytopenia.peripheral oedema.renal impairment.
severe cutaneous adverse reactions (SCARs).shock.skin
reactions.taste altered.thrombocytopenia.tremor.
vomiting
lPREGNANCYManufacturer advises avoid unless
essential—toxicity inanimalstudies.372 Fungal infection BNFC 2018 – 2019
Infection5