Effect of neutropenia and treatment delay on the response to antifungal agents in experimental disseminated candidiasis

Antimicrob Agents Chemother. 2007 Jan;51(1):285-95. doi: 10.1128/AAC.00601-06. Epub 2006 Nov 6.

Abstract

Disseminated candidiasis is associated with a high rate of morbidity and mortality. The presence of neutrophils and the timely administration of antifungal agents are likely to be critical factors for a favorable therapeutic outcome of this syndrome. The effect of neutropenia on the temporal profile of the burden of Candida albicans in untreated mice and those treated with amphotericin B was determined using a pharmacodynamic model of disseminated candidiasis. A mathematical model was developed to describe the rate and extent of the C. albicans killing attributable to neutrophils and to amphotericin B. The consequences of a delay in the administration of amphotericin B, flucytosine, or micafungin were studied by defining dose-response relationships. Neutrophils caused a logarithmic decline in fungal burden in treated and untreated mice. The combination of amphotericin B and neutrophils resulted in a high rate of Candida killing and a sustained anti-C. albicans effect. In neutropenic mice, 5 mg/kg of body weight of amphotericin B was required to prevent progressive logarithmic growth. An increased delay in drug administration resulted in a reduction in the maximum effect to a point at which no drug effect could be observed. Neutrophils and the timely initiation of antifungal agents are critical determinants in the treatment of experimental disseminated candidiasis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Amphotericin B / pharmacology
  • Amphotericin B / therapeutic use
  • Animals
  • Antifungal Agents / pharmacology
  • Antifungal Agents / therapeutic use*
  • Candida albicans / drug effects
  • Candidiasis / drug therapy*
  • Candidiasis / pathology
  • Disease Models, Animal
  • Dose-Response Relationship, Drug
  • Echinocandins
  • Flucytosine / pharmacology
  • Flucytosine / therapeutic use
  • Kidney / drug effects
  • Kidney / metabolism
  • Kidney / pathology
  • Lipopeptides
  • Lipoproteins / pharmacology
  • Lipoproteins / therapeutic use
  • Male
  • Micafungin
  • Mice
  • Microbial Sensitivity Tests
  • Neutropenia / pathology
  • Neutropenia / physiopathology*
  • Neutrophils / drug effects
  • Neutrophils / pathology
  • Peptides, Cyclic / pharmacology
  • Peptides, Cyclic / therapeutic use
  • Time Factors

Substances

  • Antifungal Agents
  • Echinocandins
  • Lipopeptides
  • Lipoproteins
  • Peptides, Cyclic
  • Amphotericin B
  • Flucytosine
  • Micafungin