Title:Echinocandins for the Nursery: An Update
VOLUME: 14 ISSUE: 2
Author(s):Paolo Manzoni, Daniel K. Benjamin, Caterina Franco, Stefano Rizzollo, Mauro Stronati, Kevin Watt, Michael Cohen-Wolkowiez and Evelyne Jacqz-Aigrain
Affiliation:Neonatology and NICU, S. Anna Hospital, Azienda Ospedaliera Regina Margherita - S. Anna, C.so Spezia 60. 10126 Torino, Italy.
Keywords:Neonate, echinocandin, micafungin, caspofungin, anidulafungin, candida, infection, IFI, Amphotericin B., Candida spp, Antifungal Spp, Fluconazole, C. Parapsilosis
Abstract:As the incidence rates of neonatal invasive fungal infection (IFI) have been increasing over the last years, research efforts have
been addressed towards identifying both effective preventative strategies, and efficacious and well-tolerated antifungal drugs. Historically,
the first options in treatment of neonatal IFI have been –and currently are- fluconazole and amphotericin B. However, these two
drugs carry limitations both in efficacy and in putative toxicity. Recently, new therapeutic alternatives have drawn the neonatologists’ attention.
Echinocandins are a new class of antifungal drugs with characteristics that might better meet the needs of this particular population
of patients. Caspofungin, Micafungin and Anidulafungin have inherent good activities both against biofilms, and against natively
fluconazole-resistent strains of Candida spp, thus overcoming two of the major weaknesses of the commonly used antifungal drugs in
nurseries.
Caspofungin and Micafungin have been recently studied in neonatal populations. The kinetics and appropriate dosing of this agent in
premature and term infants have been described, but ongoing further studies are needed to better address this area. Extrapolation of data
from randomized trials conducted in pediatric and adult patients showed through a subgroup analysis that both Caspofungin and Micafungin
are effective and well tolerated also in neonates.
Further studies properly designed for neonatal populations will better address long-term safety and echological issues related to Echinocandin
use in neonates.
