A prospective, multicenter study of caspofungin for the treatment of documented Candida or Aspergillus infections in pediatric patients.
We evaluated the safety, tolerability, and efficacy of caspofungin in pediatric patients with invasive aspergillosis, invasive candidiasis, or esophageal candidiasis.



This was a multicenter, prospective, open-label study in children 3 months to 17 years of age with proven or probable invasive aspergillosis, proven invasive candidiasis, or proven esophageal candidiasis. All of the patients received caspofungin 70 mg/m(2) on day 1, followed by 50 mg/m(2) per day (maximum: 70 mg/day), as primary or salvage monotherapy. Favorable response was defined as complete resolution of clinical findings and microbiologic (or radiographic/endoscopic) eradication (complete response) or significant improvement in these parameters (partial response). Efficacy was assessed at the end of caspofungin therapy in patients with a confirmed diagnosis who received >/=1 dose of caspofungin. The primary safety evaluation was the proportion of patients with clinical or laboratory drug-related adverse events.



Of the 49 patients enrolled, 3 were <2 years of age, 30 were 2 to 11 years of age, and 16 were 12 to 17 years of age. Forty-eight patients had confirmed disease: invasive aspergillosis (10), invasive candidiasis (37), and esophageal candidiasis (1). Eight of 10 patients with invasive aspergillosis had pulmonary involvement; 34 of 37 patients with invasive candidiasis had candidemia. Caspofungin was given for 2 to 87 days. Success at end of therapy was achieved in 5 of 10 patients with invasive aspergillosis, 30 of 37 with invasive candidiasis, and 1 of 1 with esophageal candidiasis. One patient (invasive candidiasis) relapsed during the 28-day follow-up period. Drug-related clinical or laboratory adverse events occurred in 27% and 35% of patients, respectively. There were no serious drug-related adverse events or discontinuations of caspofungin because of toxicity.



Caspofungin was generally well tolerated in pediatric patients aged 6 months through 17 years. Efficacy outcomes in patients with invasive aspergillosis or invasive candidiasis were consistent with previous adult studies in these indications.
Zaoutis
Theoklis E
TE
Children's Hospital of Philadelphia, Division of Infectious Diseases, 34th Street and Civic Center Boulevard, CHOP North, Suite 1527, Philadelphia, PA 19104, USA. zaoutis@email.chop.edu
Jafri
Hasan S
HS
Huang
Li-Min
LM
Locatelli
Franco
F
Barzilai
Asher
A
Ebell
Wolfram
W
Steinbach
William J
WJ
Bradley
John
J
Lieberman
Jay M
JM
Hsiao
Chih-Cheng
CC
Seibel
Nita
N
Laws
Hans-Juergen
HJ
Gamba
Melinda
M
Petrecz
Maria
M
Taylor
Arlene F
AF
Strohmaier
Kim M
KM
Chow
Joseph W
JW
Kartsonis
Nicholas A
NA
Ngai
Angela L
AL
D000293:Adolescent; D000935:Antifungal Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001228:Aspergillosis / Q000188:drug therapy*; D002177:Candidiasis / Q000188:drug therapy*; D000077336:Caspofungin; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D064420:Drug-Related Side Effects and Adverse Reactions; D054714:Echinocandins / Q000009:adverse effects / Q000627:therapeutic use*; D004935:Esophageal Diseases / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D055666:Lipopeptides; D008111:Liver Function Tests; D008297:Male; D009894:Opportunistic Infections / Q000188:drug therapy*; D011446:Prospective Studies; D055732:Pulmonary Aspergillosis / Q000188:drug therapy*; D012008:Recurrence; D016896:Treatment Outcome
D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D000077336:Caspofungin