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Efficacy and Safety of Echinocandins for the Treatment of Invasive Candidiasis in Children

A Meta-analysis

Tsekoura, Magdalini, MD, MSc*,†; Ioannidou, Maria, MD, MSc*,‡; Pana, Zoi-Dorothea, MD, MSc, PhD*,‡; Haidich, Anna-Bettina, PhD§; Antachopoulos, Charalampos, MD, PhD*; Iosifidis, Elias, MD, MSc, PhD*; Kolios, George, MD, PhD; Roilides, Emmanuel, MD, PhD*

The Pediatric Infectious Disease Journal: January 2019 - Volume 38 - Issue 1 - p 42–49
doi: 10.1097/INF.0000000000002032
Antimicrobial Reports

Background: Echinocandins are recommended for the treatment of suspected or confirmed invasive candidiasis (IC) in adults. Less is known about the use of echinocandins for the management of IC in children. The aim of this study was to investigate the overall efficacy and safety of echinocandin class in neonatal and pediatric patients with IC.

Methods: PubMed, Cochrane Central, Scopus and Clinical trial registries were searched up to July 27, 2017. Eligible studies were randomized controlled trials that evaluated the efficacy and safety of any echinocandin versus agents of other antifungal classes for the treatment of IC in pediatric patients. The primary outcome was treatment success with resolution of symptoms and signs, and absence of IC. In the meta-analysis a random effects model was used, and the odds ratio (OR) and 95% confidence intervals (CIs) were calculated.

Results: Four randomized clinical trials (324 patients), 2 confirmed IC (micafungin vs. liposomal amphotericin B (L-AmB) and caspofungin vs. L-AmB) and 2 empirical therapy trials (caspofungin vs. deoxycholate amphotericin B and caspofungin vs. L-AmB) were included. There was no significant difference between echinocandins and comparator in terms of treatment success (OR = 1.61, 95% CI: 0.74–3.50) and incidence of treatment-related adverse events (OR = 0.70, 95% CI: 0.39–1.26). However, fewer children treated with echinocandins discontinued treatment because of adverse events than amphotericin B formulations (OR = 0.26, 95% CI: 0.08–0.82, P = 0.02).

Conclusions: In the treatment of IC in children, echinocandins show non-inferior efficacy compared with amphotericin B formulations with fewer discontinuations than in comparator arm.

From the *Infectious Diseases Unit, Third Department of Paediatrics, Faculty of Medicine, Aristotle University School of Health Sciences

Microbiology Department, Papanikolaou General Hospital

Second Department of Paediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, AHEPA General Hospital

§Department of Hygiene and Epidemiology, Aristotle University School of Health Sciences, Thessaloniki, Greece

Laboratory of Pharmacology, Faculty of Medicine, Democritus University of Thrace, Alexandroupolis, Greece.

Accepted for publication February 19, 2018.

The authors have no conflicts of interest to disclose.

E.R. has received research grant support from Pfizer and Gilead, has served as consultant to Astellas Gilead, Pfizer and Merck and has been in the speakers’ bureau of Merck, Aventis, Astellas and Pfizer. The other authors have no conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (www.pidj.com).

Address for correspondence: Emmanuel Roilides, MD, PhD, Infectious Diseases Unit, Third Department of Paediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki 541 24, Greece. E-mail: roilides@med.auth.gr.

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