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Efficacy and Safety of Echinocandins for the Treatment of Invasive Candidiasis in Children: A Meta-analysis.

TitleEfficacy and Safety of Echinocandins for the Treatment of Invasive Candidiasis in Children: A Meta-analysis.
Publication TypeJournal Article
Year of Publication2019
AuthorsTsekoura, M., Ioannidou M., Pana Z-D., Haidich A-B., Antachopoulos C., Iosifidis E., Kolios G., & Roilides E.
JournalPediatr Infect Dis J
Volume38
Issue1
Pagination42-49
Date Published2019 01
ISSN1532-0987
KeywordsAdolescent, Amphotericin B, Antifungal Agents, Candidiasis, Invasive, Caspofungin, Child, Child, Preschool, Deoxycholic Acid, Drug Combinations, Echinocandins, Female, Humans, Infant, Infant, Newborn, Lipopeptides, Male, Micafungin, Randomized Controlled Trials as Topic, Treatment Outcome
Abstract

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.

DOI10.1097/INF.0000000000002032
Alternate JournalPediatr Infect Dis J
PubMed ID29596219

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