Echinocandins vs. amphotericin B against invasive candidiasis in children and neonates: A meta-analysis of randomized controlled trials

Chen, Yu-Hung; Cheng, I-Ling; Lai, Chih‐Cheng; Tang, Hung‐Jen

doi:10.1016/j.ijantimicag.2019.02.019

Cited by 11 publications

(10 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Despite the extensive use in neonates and premature infants with suspected or proven invasive fungal infection, there are no robust PK data on liposomal amphotericin B in this population and no good information on optimal dosing regimens. Efficacy and safety comparison studies between echinocandins and amphotericin B formulation to treat Candida infections in neonates and infants conclude that there are no differences in efficacy and echinocandins give fewer adverse events than amphotericin B formulation [112][113][114]. All these studies explain the importance to further implement PK data availability of these drugs on neonates.…”

Section: Tdm and Antifungalsmentioning

confidence: 99%

Therapeutic Drug Monitoring Is a Feasible Tool to Personalize Drug Administration in Neonates Using New Techniques: An Overview on the Pharmacokinetics and Pharmacodynamics in Neonatal Age

Rose

Cairoli

Dionisi

et al. 2020

IJMS

View full text Add to dashboard Cite

Therapeutic drug monitoring (TDM) should be adopted in all neonatal intensive care units (NICUs), where the most preterm and fragile babies are hospitalized and treated with many drugs, considering that organs and metabolic pathways undergo deep and progressive maturation processes after birth. Different developmental changes are involved in interindividual variability in response to drugs. A crucial point of TDM is the choice of the bioanalytical method and of the sample to use. TDM in neonates is primarily used for antibiotics, antifungals, and antiepileptic drugs in clinical practice. TDM appears to be particularly promising in specific populations: neonates who undergo therapeutic hypothermia or extracorporeal life support, preterm infants, infants who need a tailored dose of anticancer drugs. This review provides an overview of the latest advances in this field, showing options for a personalized therapy in newborns and infants.

show abstract

Section: Tdm and Antifungalsmentioning

confidence: 99%

Therapeutic Drug Monitoring Is a Feasible Tool to Personalize Drug Administration in Neonates Using New Techniques: An Overview on the Pharmacokinetics and Pharmacodynamics in Neonatal Age

Rose

Cairoli

Dionisi

et al. 2020

IJMS

View full text Add to dashboard Cite

show abstract

“…Amphotericin B and amphotericin B liposomes are still the recommended first-line drugs, although side effects such as hypokalemia, myocardial injury, and acute kidney injury (AKI) are not rarely seen. Chen et al (2019) reported a meta-analysis to evaluate efficacy and safety of echinocandins vs. amphotericin B in children and neonates, which revealed that the amphotericin B group had a higher risk of treatment discontinuation because of adverse effects. Fluconazole had a good effect in the past, but with increased prophylactic treatment, there has been emergence of drug-resistant strains.…”

Section: Discussionmentioning

confidence: 99%

Clinical Analysis of Intravenous and Oral Sequential Treatment With Voriconazole for Candida Central Nervous System Infection in Six Premature Infants

Zhu

Gong

et al. 2021

Front. Pharmacol.

View full text Add to dashboard Cite

Objective: The aim of the study was to observe the clinical efficacy and safety of intravenous and oral sequential treatment with voriconazole for Candida central nervous system (CNS) infection in premature infants.Methods: The study included retrospective analysis of the clinical data of six premature infants with Candida CNS infection admitted to the neonatology department in Shanghai Children’s Hospital between November 2016 and November 2019. By reviewing the characteristics of voriconazole based on the literature, it showed that infants without gastrointestinal dysfunction could be effectively treated by intravenous and oral sequential therapy with voriconazole (both 7 mg/kg/dose, every 12 h). Clinical manifestations, the time required for the cerebrospinal fluid (CSF), blood culture, nonspecific infection markers such as platelets and C-reactive protein (CRP) to turn normal, and drug-related side effects were observed and recorded in the process of treatment. All data were statistically analyzed by T test and Mann–Whitney U test.Results: A total of six premature infants were diagnosed with Candida CNS infection, two cases were diagnosed by a positive CSF culture and four cases were clinically diagnosed. Blood culture was positive for Candida in five cases. Among the 6 patients, 4 cases were Candida albicans and 2 cases were Candida parapsilosis. All the six cases were cured. After 3–5 days of treatment, symptoms such as lethargy, apnea, and feeding intolerance were improved and disappeared; a repeated blood culture turned negative in 3–7 days; CSF returned to normal in 15 ± 9 days on an average. Brain abscess, meningeal inflammation, and other infectious lesions were cleared on cranial magnetic resonance imaging (MRI) after treatment. The average total course of voriconazole was 61 ± 29 days, and the average oral treatment was 28 ± 15 days. No Candida recurrence was found during the treatment, and no drug-related side effects such as skin rash, liver and kidney function impairment, or visual abnormalities were found. The white blood cells, CSF glucose/plasma glucose ratio, and protein in CSF were significantly improved after the treatment (p < 0.05). No statistically significant difference was identified in the liver and kidney function indexes (p > 0.05).Conclusion: Voriconazole is a relatively safe and effective alternative treatment for Candida CNS infection in preterm infants. No severe drug-related side effects were detected.

show abstract

“…217,218 A recent meta-analysis, which included five randomised control trials of 354 patients (191 patients in the echinocandins group and 163 patients in the amphotericin B group), showed no differences in efficacy between the echinocandins and amphotericin B (D-AMB or L-AMB) in the treatment of IC in children (OR 1.38), although the echinocandin group had a significantly lower risk of discontinuing treatment than the amphotericin B group. 217 In children, echinocandin choice has been dictated by licensing in children and with limited safety and dosing data predominantly available for micafungin or caspofungin, these are favoured. Nonetheless, anidulafungin has emerging evidence for safety and efficacy with global response success rate of 70.8% in children and 68.8% in infants (1 month to 2 years of age), with similar pharmacokinetics to adults.…”

Section: Infants and Childrenmentioning

confidence: 99%

Consensus guidelines for the diagnosis and management of invasive candidiasis in haematology, oncology and intensive care settings, 2021

Keighley

Cooley

Morris

et al. 2021

Internal Medicine Journal

View full text Add to dashboard Cite

Patients with haematological malignancies, haemopoietic stem cell transplant recipients and patients requiring admission to intensive care settings are at high risk for invasive candidiasis (IC). Over the past decade, there has been increased reporting of nonalbicans species and fluconazole resistance in Australia. These guidelines provide updated evidence-based recommendations for the diagnosis and management of IC in adult and paediatric haematology, oncology and intensive care settings. Optimal pharmacological and non-pharmacological management are discussed. Recent studies strengthen the recommendation for an echinocandin agent as first-line therapy for high-risk patients with IC. Mortality benefit has also been demonstrated for nonpharmacological management, including removal of central venous catheters, infectious diseases consultation and use of care bundles. Healthcare facilities managing immunocompromised patient populations should therefore adopt implementation strategies for these multimodal interventions.

show abstract

Echinocandins vs. amphotericin B against invasive candidiasis in children and neonates: A meta-analysis of randomized controlled trials

Cited by 11 publications

References 22 publications

Therapeutic Drug Monitoring Is a Feasible Tool to Personalize Drug Administration in Neonates Using New Techniques: An Overview on the Pharmacokinetics and Pharmacodynamics in Neonatal Age

Therapeutic Drug Monitoring Is a Feasible Tool to Personalize Drug Administration in Neonates Using New Techniques: An Overview on the Pharmacokinetics and Pharmacodynamics in Neonatal Age

Clinical Analysis of Intravenous and Oral Sequential Treatment With Voriconazole for Candida Central Nervous System Infection in Six Premature Infants

Consensus guidelines for the diagnosis and management of invasive candidiasis in haematology, oncology and intensive care settings, 2021

Contact Info

Product

Resources

About