title: Safety of micafungin in infants: insights into optimal dosing.
abstract: BACKGROUND
  Invasive Candida infections are a leading cause of mortality and morbidity in neonatal intensive care units (NICUs). Micafungin is a promising therapeutic option for treatment of invasive fungal infections in infants given its safety profile in older children and adults. Understanding micafungin safety in infants is particularly important because antifungals are most often used in premature infants with multiple underlying medical conditions in a critical care setting.
  
  
  METHODS
  This article reviews the literature evaluating the safety profile of micafungin in infants and offers recommendations for optimal dosing for treatment of invasive candidiasis in the NICU setting. The review has been performed using a Medline search in September 2010 for related articles from 1990 to the present with the Mesh related terms 'micafungin' and 'safety' in combination with the free words 'antifungal', 'candidiasis', 'drug toxicity', 'infant, premature' and 'infant, newborn'.
  
  
  CONCLUSIONS
  Despite the limitations of the existing literature, we believe micafungin dosing of 10 mg/kg/day for all term and preterm infants is a viable treatment option in the NICU setting for management of invasive candidiasis. Although the number of infants for whom safety data are reported is small, higher doses of micafungin appear safe and well tolerated in this population.
authors.affiliation: Duke University, Department of Pediatrics, 2400 Pratt St., Durham, NC 27715, USA. danny.benjamin@duke.edu
authors.forename: Simon
authors.initials: S
authors.lastname: Ascher
authors.forename: Phillip Brian
authors.initials: PB
authors.lastname: Smith
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Benjamin
mesh_terms: D000328:Adult; D000367:Age Factors; D000818:Animals; D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics; D058365:Candidiasis, Invasive / Q000188:drug therapy*; D002648:Child; D004305:Dose-Response Relationship, Drug; D054714:Echinocandins / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D055666:Lipopeptides / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics; D000077551:Micafungin
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D000077551:Micafungin