title: Micafungin twice weekly as antifungal prophylaxis in paediatric patients at high risk for invasive fungal disease.
abstract: BACKGROUND
  Current guidelines recommend antifungal prophylaxis for children at high risk for invasive fungal disease (IFD), but the use of polyenes and triazoles may not be feasible in some patients due to toxicities and drug-drug interactions. Micafungin is well tolerated, with intravenous daily dosing being the current standard. Recent reports indicate safety and efficacy of intermittent dosing of micafungin.
  
  
  METHODS
  We analysed safety, efficacy and micafungin serum concentrations of children at high risk for IFD receiving prophylactic micafungin between 3 and 4 mg/kg twice weekly. All children were intolerant or had contraindications to polyenes and triazoles.
  
  
  RESULTS
  A total of 21 children (median age = 9 years) at high risk for IFD were included in the analysis. No significant clinical adverse event occurred, and end of treatment values of parameters of renal and hepatic function in serum were not different from baseline. Proven or probable breakthrough IFD did not occur in any of the patients. In 9 out of 11 patients in whom plasma micafungin concentrations were assessed, the first trough concentration exceeded 150 ng/mL, a concentration proposed to be effective for prophylaxis.
  
  
  CONCLUSIONS
  Our data indicate that micafungin administered twice weekly at a dosage of 3-4 mg/kg of bodyweight could be a convenient, safe and efficient alternative for antifungal prophylaxis in children at high risk for IFD.
authors.affiliation: Pediatric Hematology and Oncology, Johann Wolfgang Goethe-University, Frankfurt, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Bochennek
authors.affiliation: Pediatric Hematology and Oncology, Johann Wolfgang Goethe-University, Frankfurt, Germany 'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania.
authors.forename: A
authors.initials: A
authors.lastname: Balan
authors.affiliation: Pediatric Hematology and Oncology, Johann Wolfgang Goethe-University, Frankfurt, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Müller-Scholden
authors.affiliation: Pediatric Hematology and Oncology, Johann Wolfgang Goethe-University, Frankfurt, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Becker
authors.affiliation: Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Farowski
authors.affiliation: Department of Pharmacology, University Hospital of Cologne, Cologne, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Müller
authors.affiliation: Infectious Disease Research Program, Center for Bone Marrow Transplantation and Department of Pediatric Hematology/Oncology, University Children's Hospital Münster, Münster, Germany.
authors.forename: A H
authors.initials: AH
authors.lastname: Groll
authors.affiliation: Pediatric Hematology and Oncology, Johann Wolfgang Goethe-University, Frankfurt, Germany thomas.lehrnbecher@kgu.de.
authors.forename: T
authors.initials: T
authors.lastname: Lehrnbecher
mesh_terms: D000293:Adolescent; D000935:Antifungal Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D018890:Chemoprevention / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D054714:Echinocandins / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D005260:Female; D016469:Fungemia / Q000517:prevention & control*; D006801:Humans; D007223:Infant; D007677:Kidney Function Tests; D055666:Lipopeptides / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D008111:Liver Function Tests; D008297:Male; D000077551:Micafungin; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D000077551:Micafungin
keywords: cancer; child; haematopoietic stem cell transplantation