A sensitive liquid chromatography-tandem mass spectrometry method for monitoring the caspofungin trough plasma concentration and its association with caspofungin efficacy in intensive-care-unit patients. Issue 127 (11th December 2015)

• Record Type: Journal Article
• Authors: Yang, Qianting; Wang, Taotao; Xie, Jiao; Chen, Lu; Wang, Yan; Cheng, Xiaoliang; Dong, Haiyan; Dong, Weihua; Wei, Youxia; Wang, Xue; Dong, Yalin
• Is Part Of: RSC advances. Volume 5:Issue 127(2015)
• Page Start: 104806
• Page End: 104814
• Publication Date: 2015-12-11
• Subjects: Chemistry -- Periodicals; 540.5
• DOI: 10.1039/c5ra21080a
• Languages: English
• ISSNs: 2046-2069

Abstract

Abstract : LC-MS/MS method for monitoring the caspofungin trough plasma concentration and its association efficacy in intensive-care-unit patients. Abstract : Caspofungin is a common treatment for fungal infections in intensive care unit (ICU) patients, and in these patients their pharmacokinetics are highly variable. So a rapid and sensitive liquid chromatography-tandem mass spectrometry (LC-MS/MS) method was established for measuring C min in 18 ICU patients, and the exposure–response characteristics of caspofungin were investigated. The calibration curve included clinically relevant caspofungin concentrations, ranging from 0.05 to 20 mg L −1 . The mean recovery rate ranged from 85.2% to 95.3%, while the intra- and interday precisions were <5.5% and their accuracies were within the range of 96.2–102.3%. The overall C min was 2.13 ± 0.99 mg L −1 (mean ± SD; range, 0.51–3.79 mg L −1 ). Patients were infected by either Candida spp. ( n = 13) or Aspergillus spp. ( n = 5), and caspofungin therapy was effective in 66.7% ( n = 12) of them. 76.9% (10/13) patients (infected by Candida spp. and C min > 1 mg L −1 ) achieved clinical success while 23.1% (3/13) patients ( C min > 1 mg L −1 : n = 1; C min < 1 mg L −1 : n = 2) failed to show a clinical response. All five patients infected by Aspergillus spp. had a mean plasma C min above 0.5 mg L −1, and only two achieved clinical success. Validated LC-MS/MS is a simple, rapid and accurate method that is suitable for monitoring the concentration of caspofungin. C min exhibits a wide range in ICU patients, and relatively good treatment results are obtainable when C min exceeds the 90% minimal inhibitory concentration ( Candida spp: 1 mg L −1 ; Aspergillus spp: 0.5 mg L −1 ).