Micafungin
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Lack of efficacy: case report. A 59-year-old man exhibited lack of effect of micafungin, indicated for empyema due to Candida albicans infections. The man was hospitalised 8 days after esophageal carcinoma radical surgery, for stethalgia treatment. Chest X-ray demonstrated pleural effusion in left chest. A large amount of yellow-green chest liquid was drained. However, he showed no improvement. After treatment with imipenem/cilastinin, he presented with sputum, phlegm, shortness of breath, chest tightness, fatigue, weakness and other unspecified symptoms. Following admission, he was shifted to ICU, where he was ventilated and intubated. He developed empyema due to Candida albicans infection. In the ICU, he received micafungin 150 mg/day [route not stated]. After 3 days of micafungin initiation, his WBC was found to be 15.05 x 109/L (neutrophils 92.6% and procalcitonin 9.44 ng/mL). Sputum culture showed low level of fungus. Blood culture and pleural fluid drainage revealed Candida albicans. An X-ray of the chest demonstrated atelectasis, compressed about 70% in left chest and appearance of hydropneumothorax. Exudative lesions of the lungs were considered to be inflammatory. Despite micafungin treatment no improvement was noted. Therefore, micafungin was changed to amphotericin B. He was premedicated with prophylactic promethazine before initiation of amphotericin B. Subsequently, he underwent pleural lavage of amphotericin B. On day 12, fluid culture returned negative for Candida albicans. Thereafter, he was extubated. Pleural lavaging with amphotericin B was continued daily until consecutive cultures were found to be negative twice (on day 15 and 18). Thereafter, IV amphotericin B was continued for 1-month until he improved. Thereafter, he was discharged. Qian Z, et al. REPORT-Pleural lavage of amphotericin B for treatment of empyema caused by Candida albicans infections: A case report. Pakistan Journal of Pharmaceutical 803499342 Sciences 32: 2757-2759, No. 6, Nov 2019. Available from: URL: http://www.pjps.pk/wp-content/uploads/pdfs/32/6/Paper-30.pdf
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Reactions 5 Sep 2020 No. 1820
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