title: Micafungin use in children.
abstract: Invasive fungal infections (IFIs) are one of the major reasons for morbidity and mortality in immunocompromised children. The majority of IFIs are caused by Candida and Aspergillus species. Early diagnosis and prompt initiation of appropriate antifungal therapy is essential for favorable outcome. Micafungin is a member of the echinocandins, a novel class of antifungal agents that target the biosynthesis of β-1,3-D-glucan, a key fungal cell wall component. It has concentration-dependent fungicidal activity against Candida species and fungistatic activity against Aspergillus species. Although optimal dosing of micafungin in children has not been established, the recommended dosage in children is 2 mg/kg/day (100 mg/day if >40 kg bodyweight) for invasive candidiasis, 1 mg/kg/day (50 mg/day if >40 kg bodyweight) for the prophylaxis of Candida infections in patients with anticipated prolonged and severe neutropenia or in allogeneic hematopoietic stem cell transplantation recipients. Micafungin has a favorable safety and drug-drug interaction profile. The most common adverse effects in children are diarrhea, epistaxis, abdominal pain, headache, nausea, vomiting, fever, chills, elevation of alanine aminotransferase/aspartate aminotransferase values, hypokalemia, thrombocytopenia, mucositis, and rash. Because of its different mechanisms of action, micafungin shows promise as part of the prophylactic and therapeutic management of IFIs, but larger prospective and comparative trials are needed for widespread use in children.
authors: Konya Training and Research Hospital, Department of Pediatric Infectious Diseases, 42040 Konya, Turkey. mkeser17@gmail.com
authors: Melike
authors: M
authors: Emiroglu
mesh_terms: D000293:Adolescent; D000935:Antifungal Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D001228:Aspergillosis / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology / Q000382:microbiology / Q000503:physiopathology; D001230:Aspergillus / Q000187:drug effects* / Q000502:physiology; D002175:Candida / Q000187:drug effects* / Q000502:physiology; D058365:Candidiasis, Invasive / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology / Q000382:microbiology / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D002986:Clinical Trials as Topic; D004334:Drug Administration Schedule; D054796:Drug Dosage Calculations; D042241:Early Diagnosis; D054714:Echinocandins / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D016867:Immunocompromised Host; D007223:Infant; D055666:Lipopeptides / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D000077551:Micafungin; D008826:Microbial Sensitivity Tests; D016533:Mycological Typing Techniques; D009503:Neutropenia / Q000517:prevention & control; D014184:Transplantation, Homologous
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D000077551:Micafungin