In this episode, I’ll discuss whether 100 mg of micafungin is enough for critically ill obese patients.
The recommended dose of micafungin for candidemia is 100mg, but is this enough to achieve adequate levels in obese patients?
A meta-analysis published in the journal Critical Care attempts to answer this question.
Plasma micafungin concentrations were determined in 10 critically ill non-obese patients, 10 non-critically ill obese patients, and 11 critically ill morbidly obese patients.
Using a monte-carlo analysis, daily IV doses were simulated for 100 mg, 150 mg, and 200 mg given to patients at body weights of 45, 80, 115, 150, and 185 kg and ages of 30, 50, 70 and 90 years old.
The model showed that both weight and age were significant variables in attaining adequate plasma levels.
A dosing regimen was considered successful if the fractional target attainment using published MIC distributions was at least 90%.
For candida albicans, the model showed a micafungin dose of 150 mg was adequate for patients weighing under 115 kg and a dose of 200 mg was adequate for patients weighing up to 185 kg.
For candida glabrata, the model showed a micafungin dose of 200 mg was adequate only for patients weighing under 115 kg.
This article suggests that higher micafungin doses are needed for obese patients to adequately cover candida.
The authors reference a 2006 study where patients appeared to tolerate micafungin in doses of up to 8 mg/kg/day for as long as 28 days to support the safety of using higher micafungin doses in obese patients.
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