An overview of micafungin as a treatment option for invasive candidiasis in pediatric patients younger than 4 months old

ABSTRACT

Introduction

Invasive candidiasis remains a leading cause of morbidity and mortality in various categories of patients at risk.

Areas covered

Structure and mechanism of action, pharmacokinetics and pharmacodynamics, clinical studies, safety, and regulatory status of micafungin are explored in the present review, focusing on pediatric patients younger than 4 months old.

Expert opinion

Although limited, the available data on the efficacy and safety of micafungin in pediatric patients younger than 4 months old support its use for the treatment of invasive candidiasis in this particular population, in line with the most updated recommendations from the European Medicines Agency and the US Food and Drug Administration. Additional study, especially of high-dose micafungin, could further optimize the use of this drug in pediatric patients younger than 4 months old with Candida meningoencephalitis. The recent worrisome worldwide diffusion of Candida auris, more frequently resistant to polyenes than to echinocandins and showing high rates of resistance to azoles, could render micafungin even more crucial for guaranteeing an efficacious antifungal treatment for invasive candidiasis in pediatric patients younger than 4 months old.

KEYWORDS:

• Micafungin
• echinocandins
• neonatal candidiasis
• ELBW infants
• candidemia
• Candida meningoencephalitis
• deep-seated candidiasis

Declaration of interest

M Bassetti reports research grants and/or advisor/consultant and/or speaker/chairman fees from Bayer, BioMérieux, Cidara, Cipla, Gilead, Menarini, MSD, Pfizer, and Shionogi outside the submitted work. D R Giacobbe reports investigator-initiated grants from Pfizer, Shionogi, and Gilead Italia, and speaker and/or advisory board fees from Pfizer and Tillotts Pharma outside the submitted work. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.