An overview of micafungin as a treatment option for invasive candidiasis in pediatric patients younger than 4 months old.

INTRODUCTION: Invasive candidiasis remains a leading cause of morbidity and mortality in various categories of patients at risk. AREAS COVERED: Structure and mechanism of action, pharmacokinetics and pharmacodynamics, clinical studies, safety, and regulatory status of micafungin are explored in the present review, focusing on pediatric patients younger than 4 months old. EXPERT OPINION: Although limited, the available data on the efficacy and safety of micafungin in pediatric patients younger than 4 months old support its use for the treatment of invasive candidiasis in this particular population, in line with the most updated recommendations from the European Medicines Agency and the US Food and Drug Administration. Additional study, especially of high-dose micafungin, could further optimize the use of this drug in pediatric patients younger than 4 months old with Candida meningoencephalitis. The recent worrisome worldwide diffusion of Candida auris, more frequently resistant to polyenes than to echinocandins and showing high rates of resistance to azoles, could render micafungin even more crucial for guaranteeing an efficacious antifungal treatment for invasive candidiasis in pediatric patients younger than 4 months old.