College of Pharmacy, Ferris State University, Bronson Methodist Hospital, Kalamazoo, MI 49007, USA.
Ann Pharmacother. 2010 Jan;44(1):166-77. doi: 10.1345/aph.1M139. Epub 2009 Dec 15.
To identify and evaluate available data on pediatric echinocandin use.
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.
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.
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.
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.
确定和评估儿科棘白菌素使用的现有数据。
使用搜索词棘白菌素、儿科、儿童、药代动力学、卡泊芬净、米卡芬净和安尼芬净，对 PubMed 进行了一项英语文章限制的搜索（1990 年-2009 年 8 月）。从选定参考文献的引文检索中检索到其他文章。
选择了有关儿童棘白菌素的药理学、药代动力学、疗效和安全性的相关信息。确定并评估了临床试验、回顾性综述和病例系列。这些来源的数据包含在本次综述中。
卡泊芬净是唯一一种经食品和药物管理局批准用于儿童的棘白菌素。已对所有 3 种棘白菌素进行了儿科药代动力学评估，但安尼芬净的评估有限。米卡芬净是在干细胞移植中的抗真菌预防和侵袭性真菌感染治疗的前瞻性临床试验中研究最充分的药物。卡泊芬净已被前瞻性研究用于发热性中性粒细胞减少和侵袭性真菌感染的治疗，但大多数已发表的数据来自回顾性综述或病例报告。有 1 篇关于安尼芬净治疗新生儿念珠菌病的病例报告。棘白菌素在治疗儿童侵袭性真菌感染中的作用已扩大。米卡芬净和卡泊芬净被推荐为念珠菌血症和食管或侵袭性念珠菌病的主要或替代治疗药物，以及侵袭性曲霉病的补救治疗药物。米卡芬净被推荐用于干细胞移植中的中性粒细胞减少预防，而卡泊芬净可在发热性中性粒细胞减少症中替代唑类药物使用。仅在 3 个月及以上的儿童中，已确定卡泊芬净的剂量。在更多药代动力学和临床数据可用之前，应避免在儿童中使用安尼芬净。
需要进一步的比较试验来更清楚地确定棘白菌素在儿科人群中的作用，无论是作为单一疗法还是作为治疗难治性感染的联合疗法。
