Echinocandins in Pediatrics
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Universal Activity Number: 407-000-10-004-H01-P
CEUs 0.1
Audience: Pharmacist
Activity Type: Application-based
Issued date: 01/01/2010
Expiration date: 01/01/2013
Submit your answers by clicking here
completed purchase is required to receive the corresponding CEUs.
CEUs 0.1
Audience: Pharmacist
Activity Type: Application-based
Issued date: 01/01/2010
Expiration date: 01/01/2013
Submit your answers by clicking here
completed purchase is required to receive the corresponding CEUs.
Article title:
A Clinical Review of Echinocandins in Pediatric Patients
Goal
This review summarizes the pharmacology, pharmacokinetics, and clinical studies of echinocandins in the pediatric population. The practicing pharmacist will use this information to provide evidence- based recommendations for echinocandin use in children with fungal infections.
Objectives
Upon completion of this CE article, the reader will be able to:
- Determine which, if any, echinocandin agent is appropriate to treat a pediatric fungal infection, given its activity, mechanism of action, pharmacokinetics, and pharmacodynamics.
- Recommend an appropriate echinocandin dose for a pediatric patient with a fungal infection.
- Summarize the literature on echinocandin use in children.
- Provide evidence-based recommendations for echinocandin use in pediatric patients, given a clinical scenario.
Abstract
OBJECTIVE: To identify and evaluate available data on pediatric echinocandin use.
DATA SOURCES: A PubMed search, limited to English-language articles, was conducted (1990-August 2009) using the search terms echinocandin, pediatric, child, pharmacokinetics, caspofungin, micafungin, and anidulafungin. Additional articles were retrieved from citations of selected references.
STUDY SELECTION AND DATA EXTRACTION: Relevant information on the pharmacology, pharmacokinetics, efficacy, and safety of echinocandins in children was selected. Clinical trials, retrospective reviews, and case series were identified and evaluated. Data from these sources were included in this review.
DATA SYNTHESIS: Caspofungin is the only echinocandin approved by the Food and Drug Administration for use in children. Pediatric pharmacokinetics has been evaluated with all 3 echinocandins but is limited with anidulafungin. Micafungin is the most well-studied agent in prospective clinical trials for antifungal prophylaxis in stem cell transplantation and treatment of invasive fungal infections. Caspofungin has been studied prospectively for febrile neutropenia and treatment of invasive fungal infections, but most published data are from retrospective reviews or case reports. One case report of anidulafungin for neonatal candidiasis has been published. The role of echinocandins in the management of invasive pediatric fungal infections has expanded. Micafungin and caspofungin are recommended as primary or alternative treatment of candidemia and esophageal or invasive candidiasis, and as salvage therapy for invasive aspergillosis. Micafungin is recommended for neutropenic prophylaxis in stem cell transplantation, while caspofungin may be used in febrile neutropenia as an alternative to azoles. Dosing has been well established for caspofungin only in children 3 months of age and above. Anidulafungin should be avoided in children until more pharmacokinetic and clinical data become available.
CONCLUSIONS: Further comparative trials are needed to more clearly define the role of echinocandins, either as monotherapy or in combination for difficult-to-treat infections, in the pediatric population.
KEY WORDS: anidulafungin, caspofungin, echinocandins, micafungin, pediatrics
Ann Pharmacother 2010;44:166-177.
Published Online, 15 December 2009, www.theannals.com, DOI 10.1345/aph.1M139
Published Online, 15 December 2009, www.theannals.com, DOI 10.1345/aph.1M139