Bochennek, K., Balan, A., Muller-Scholden, L., Becker, M., Farowski, F., Muller, C., . . . Lehrnbecher, T. (2015). Micafungin twice weekly as antifungal prophylaxis in paediatric patients at high risk for invasive fungal disease. Journal of Antimicrobial Chemotherapy, 70, 1527–1530. 

To evaluate the safety and efficacy of micafungin for antifungal prophylaxis in pediatric patients at high risk for fungal infection

Children who were intolerant to polyenes and axoles or in whom theses were otherwise contraindicated were given 3–4 mg/kg micafungin twice weekly. Micafungin was begun when the patient could not take other antifungals and was continued until hematopoetic recovery after chemotherapy or until 100 days after HCT. Trough concentrations were determined from blood drawn prior to micafungin infusion, and peak levels were obtained 30 minutes after the end of the infusion.

• N = 21
• MEDIAN AGE = 9 years
• AGE RANGE = 0.2–16 years
• MALES: 66.6%, FEMALES: 33.4%
• KEY DISEASE CHARACTERISTICS: All relapse, Non-Hodgkin lymphoma, AML, or undergoing allogeneic HCT

• SITE: Single site  
• SETTING TYPE: Multiple settings  
• LOCATION: Germany

• PHASE OF CARE: Multiple phases of care
• APPLICATIONS: Pediatrics

• Observational retrospective

• IFD defined according to European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG)
• Peak and trough micafungin concentrations

There was no premature discontinuation of micafungin due to related adverse events. Proven or probably invasive fungal infection did not occur in any patients.

Findings suggest that intermittent micafungin for antifungal prophylaxis can be safe and effective in high-risk pediatric patients. Additonal larger studies are needed to confirm these results.

• Small sample (less than 30)
• Risk of bias (no control group)
• Risk of bias (no blinding)
• Risk of bias (no random assignment) 

There are a number of limitations to the use of oral triazoles for routine antifungal prophylaxis, and micfungin has been used for prevention and treatment of candida infections in children. This study showed that a larger dose, delivered intermittently, may be a safe and effective alternative for antifungal prophylaxis in high-risk children with cancer. The ability to not have to provide infusions daily can be an attractive and convenient alternative to daily treatment. This study has several important limitations, so additional well-designed research to confirm these findings in larger samples is needed.