Pediatric patients in the ICU are highly vulnerable to invasive fungal infections ; Candida has been reported to be the third most common pathogen in pediatric ICU wards . However, information on new antifungal therapies in children remains limited. Micafungin (MICA) is a once-daily antifungal agent of the echinocandin class.
A retrospective review of MICA pediatric data from six trials.
MICA was received by 296 children for invasive candidiasis, refractory invasive candidiasis, refractory invasive aspergillosis, prophylaxis in hematopoietic stem cell transplantation (HSCT) patients, or to assess pharmacokinetics (PK). Most patients aged <1 year were premature (38/66), whereas most children aged >1 year were HSCT recipients or undergoing another therapy for a hematological malignancy (181/230). Maximum daily dose was similar for patients aged <1, 1 to 4, 5 to 8, 9 to 12 and 13 to 15 years with medians of 2.0, 1.5, 1.5, 1.9 and 1.5 mg/kg, respectively. Treatment success rates are shown in Figure 1. MICA showed linear PK, with a higher clearance in neonates than in older children and adults. Common adverse events (incidence ≥ 2%) were transient increases in transaminases, hypokalemia, hyperbilirubinemia and increased alkaline phosphatase.
MICA is a safe and efficacious agent for the treatment and prophylaxis of pediatric invasive fungal infections in the ICU setting.