Artikel
Micafungin Twice Weekly as Antifungal Prophylaxis in Pediatric Patients at High Risk for Invasive Fungal Disease
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Autoren
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A. H. G. Groll
- Infectious Disease Research Program, Center for Bone Marrow Transplantation and Department of Pediatric Hematology/Oncology, University Children's Hospital Münster, Münster
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K. Bochennek
- Pediatric Hematology and Oncology, Johann Wolfgang Goethe-University, Frankfurt
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A. Balan
- Pediatric Hematology and Oncology, Johann Wolfgang Goethe-University, Frankfurt
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L. Müller-Scholden
- Pediatric Hematology and Oncology, Johann Wolfgang Goethe-University, Frankfurt
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M. Becker
- Pediatric Hematology and Oncology, Johann Wolfgang Goethe-University, Frankfurt
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F. Farowski
- Department I of Internal Medicine, University Hospital of Cologne, Cologne
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C. Müller
- Department of Pharmacology, University of Cologne, Cologne
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T. Lehrnbecher
- Infectious Disease Research Program, Center for Bone Marrow Transplantation and Department of Pediatric Hematology/Oncology, University Children's Hospital Münster, Münster
| Veröffentlicht: | 2. Oktober 2014 |
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Gliederung
Text
Current guidelines recommend antifungal prophylaxis for children at high risk for invasive fungal disease (IFD), but the use of polyenes and triazoles is limited by toxicity and drug-drug interactions. Micafungin is well tolerated, but intravenous daily dosing is the current standard. Since recent reports indicate safety and efficacy of intermittent dosing of micafungin, we analyzed the potential of antifungal prophylaxis with micafungin given at a dose between 3 and 4 mg/kg twice weekly to children at high risk for IFD, who were intolerant to or in whom polyenes and azoles were contraindicated. A total of 21 children (median age, 9 years) were included in the analysis. The median duration of severe neutropenia (absolute neutrophil count <500/µL) of the 87 analyzed episodes was 9 days. No significant clinical adverse event occurred, and end of treatment values of aspartate and alanine transaminase, bilirubin, alkaline phosphatase, and creatinine were not significantly increased compared to baseline. In none of the patients, proven or probable breakthrough IFD occurred, which was considerable less than in comparable historical controls (7/43), although this difference did not reach statistical significance. Overall, 26 (87%) of trough levels of micafungin were higher than 150 ng/mL, a concentration suggested to be effective for prophylaxis. Our data indicate that micafungin administered twice weekly at a dosage between 3 and 4 mg per kg body weight could be a convenient, safe and efficient alternative for antifungal prophylaxis in children at high risk for IFD.
