title: Echinocandins for the nursery: an update.
abstract: As the incidence rates of neonatal invasive fungal infection (IFI) have been increasing over the last years, research efforts have been addressed towards identifying both effective preventative strategies, and efficacious and well-tolerated antifungal drugs. Historically, the first options in treatment of neonatal IFI have been -and currently are- fluconazole and amphotericin B. However, these two drugs carry limitations both in efficacy and in putative toxicity. Recently, new therapeutic alternatives have drawn the neonatologists' attention. Echinocandins are a new class of antifungal drugs with characteristics that might better meet the needs of this particular population of patients. Caspofungin, Micafungin and Anidulafungin have inherent good activities both against biofilms, and against natively fluconazole-resistent strains of Candida spp, thus overcoming two of the major weaknesses of the commonly used antifungal drugs in nurseries. Caspofungin and Micafungin have been recently studied in neonatal populations. The kinetics and appropriate dosing of this agent in premature and term infants have been described, but ongoing further studies are needed to better address this area. Extrapolation of data from randomized trials conducted in pediatric and adult patients showed through a subgroup analysis that both Caspofungin and Micafungin are effective and well tolerated also in neonates. Further studies properly designed for neonatal populations will better address long-term safety and echological issues related to Echinocandin use in neonates.
authors.affiliation: Neonatology and NICU, S. Anna Hospital, Azienda Ospedaliera Regina Margherita - S. Anna, C.so Spezia 60. 10126 Torino, Italy. paolomanzoni@hotmail.com
authors.forename: Paolo
authors.initials: P
authors.lastname: Manzoni
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Benjamin
authors.forename: Caterina
authors.initials: C
authors.lastname: Franco
authors.forename: Stefano
authors.initials: S
authors.lastname: Rizzollo
authors.forename: Mauro
authors.initials: M
authors.lastname: Stronati
authors.forename: Kevin
authors.initials: K
authors.lastname: Watt
authors.forename: Michael
authors.initials: M
authors.lastname: Cohen-Wolkowiez
authors.forename: Evelyne
authors.initials: E
authors.lastname: Jacqz-Aigrain
mesh_terms: D000818:Animals; D000935:Antifungal Agents / Q000494:pharmacology / Q000627:therapeutic use*; D054714:Echinocandins / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D009181:Mycoses / Q000188:drug therapy*; D012307:Risk Factors
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins