Caspofungin

Dosing: Adult Antimicrobial Dosing, Non-dialysis

Indication Dose Notes
All indications 70 mg IV x 1, then 50 mg IV q24h No renal dose adjustment. Increase maintenance dose to 70 mg when given with CYP3A4 inducers (phenytoin, rifampin, carbamazepine, dexamethasone, or efavirenz). 
Endovascular or cardiac device-associated infection 150 mg IV q24h  

Dosing: Antimicrobial Dosing in Intermittent & Continuous Hemodialysis

Indication Dose Notes
All indications 70 mg IV x 1, then 50 mg IV q24h No dose adjustment in hemodialysis. Increase maintenance dose to 70 mg when given with CYP3A4 inducers (phenytoin, rifampin, carbamazepine, dexamethasone, or efavirenz). 

Dialysis Notes

Intermittent HD assumes high-flux hemodialysis. CRRT assumes CVVHD with ultrafiltration rate 2L/h and residual native GFR < 10 mL/min.  For detailed view of dialysis dosing and evidence, see Dosing in Hemodialysis document.

Unrestricted Indications (select indication on order entry):

1) Documented sterile site (not urine or respiratory) infection  with microbiologically confirmed Candida glabrata or Candida kruseii

2) Documented sterile site infection (not urine or respiratory) infection with yeast, pending species identification

3) Prophylaxis against fungal infections in patients on the hematology/oncology/BMT service with intolerance of or contraindications to azoles

4) Empiric therapy for prolonged febrile neutropenia in hematology/oncology/BMT patient

All other indications require approval from the Antimicrobial Stewardship Program or consulting ID fellow

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