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Echinocandins for the Nursery: An Update

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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.
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Keywords: Amphotericin B; Antifungal Spp; C. Parapsilosis; Candida spp; Fluconazole; IFI; Neonate; anidulafungin; candida; caspofungin; echinocandin; infection; micafungin

Document Type: Research Article

Publication date: February 1, 2013

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  • Current Drug Metabolism aims to cover all the latest and outstanding developments in drug metabolism and disposition. The journal serves as an international forum for the publication of timely reviews in drug metabolism. Current Drug Metabolism is an essential journal for academic, clinical, government and pharmaceutical scientists who wish to be kept informed and up-to-date with the latest and most important developments. The journal covers the following areas:

    In vitro systems including CYP-450; enzyme induction and inhibition; drug-drug interactions and enzyme kinetics; pharmacokinetics, toxicokinetics, species scaling and extrapolations; P-glycoprotein and transport carriers; target organ toxicity and interindividual variability; drug metabolism and disposition studies; extrahepatic metabolism; phase I and phase II metabolism; recent developments for the identification of drug metabolites and adducts.
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