title: Efficacy and safety of micafungin for febrile neutropenia in pediatric patients with hematological malignancies: a multicenter prospective study.
abstract: BACKGROUND
  Invasive fungal infections are a major cause of infectious mortality in neutropenic patients receiving chemotherapy or hematopoietic stem cell transplantation. However, little is known about the efficacy and safety of micafungin (MCFG), an echinocandin antifungal agent, in pediatric patients with febrile neutropenia (FN).
  
  
  METHODS
  This study was conducted as a prospective multicenter trial to evaluate the efficacy and safety of MCFG for FN in pediatric patients with hematological diseases. Efficacy was assessed based on the response to the 5 composite endpoints established by Walsh and colleagues in addition to body temperature and C-reactive protein values.
  
  
  RESULTS
  Thirty episodes of FN were enrolled in the study. The median dose and duration of MCFG treatment were 3.0 mg/kg/d and 13.5 days, respectively. Using the criteria of Walsh and colleagues, MCFG was effective in 56.7% of the patients. No breakthrough invasive fungal infection occurred during MCFG treatment. Body temperatures on the last day of neutropenia during administration of MCFG and on the last day of MCFG therapy and C-reactive protein values after administration of MCFG were significantly lower than on the day MCFG therapy was started. Adverse effects in the form of mild liver dysfunction were seen in only 2 patients.
  
  
  CONCLUSIONS
  MCFG is a very effective and safe antifungal drug for FN in children. Physicians should administer MCFG early in febrile episode in patients in whom first-line antibiotics are not effective in treating FN.
authors.affiliation: *Department of Pediatrics, Sapporo Hokuyu Hospital †Department of Pediatrics, Sapporo Medical University, School of Medicine ‡Department of Pediatrics, Asahikawa Medical College, School of Medicine §Department of Pediatrics, Hokkaido Cancer Center ∥Department of Hematology and Oncology, Hokkaido Medical Center for Child Health and Rehabilitation, Hokkaido, Japan.
authors.forename: Ryoji
authors.initials: R
authors.lastname: Kobayashi
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Suzuki
authors.forename: Makoto
authors.initials: M
authors.lastname: Yoshida
authors.forename: Susumu
authors.initials: S
authors.lastname: Iizuka
authors.forename: Daisuke
authors.initials: D
authors.lastname: Suzuki
authors.forename: Hirozumi
authors.initials: H
authors.lastname: Sano
authors.forename: Tooru
authors.initials: T
authors.lastname: Kudoh
mesh_terms: D000293:Adolescent; D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D054714:Echinocandins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005334:Fever / Q000188:drug therapy* / Q000209:etiology*; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D055666:Lipopeptides / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D000077551:Micafungin; D009503:Neutropenia / Q000188:drug therapy* / Q000209:etiology*; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D000077551:Micafungin