BNF for Children 2011-2012

BNFC 2011–2012 5.2.4 Echinocandin antifungals 307effective against fungal infections of the CNS. For therole of echinocandin antifungals in the prevention andsystemic treatment of fungal infections, see p. 300.CASPOFUNGINCautions interactions: Appendix 1 (caspofungin)Hepatic impairment usual initial dose, then use 70%of normal maintenance dose in moderate impairment;no information available for severe impairmentPregnancy manufacturer advises avoid unless essential—toxicityin animal studiesBreast-feeding present in milk in animal studies—manufacturer advises avoidSide-effects nausea, diarrhoea, vomiting; tachycardia,hypotension, flushing; dyspnoea; headache; hypokalaemia,hypomagnesaemia; arthralgia; rash, pruritus,sweating, injection-site reactions; less commonlyabdominal pain, dyspepsia, dysphagia, dry mouth,taste disturbances, anorexia, constipation, flatulence,cholestasis, hepatic dysfunction, ascites, palpitation,arrhythmia, chest pain, heart failure, thrombophlebitis,hypertension, bronchospasm, cough, dizziness,fatigue, paraesthesia, hypoaesthesia, sleep disturbances,tremor, anxiety, disorientation, hyperglycaemia,renal failure, hypocalcaemia, metabolic acidosis,anaemia, thrombocytopenia, leucopenia,myalgia, muscular weakness, blurred vision, anderythema multiforme; also reported, acute respiratorydistress syndrome, anaphylaxis, and hypercalcaemiaIndication and doseInvasive aspergillosis (see notes above); invasivecandidiasis (see notes above); empiricaltreatment of systemic fungal infections inpatients with neutropenia. By intravenous infusionNeonate 25 mg/m 2 once dailyChild 1 month–3 months 25 mg/m 2 once dailyChild 3 months–1 year 50 mg/m 2 once dailyChild 1–18 years 70 mg/m 2 (max. 70 mg) on firstday then 50 mg/m 2 (max. 70 mg) once daily;increased to 70 mg/m 2 (max. 70 mg) daily if lowerdose tolerated but inadequate responseAdministration for intravenous infusion, allow vial toreach room temperature; initially reconstitute 50 mgwith 10.5 mL Water for Injections to produce a5.2 mg/mL solution, or reconstitute 70 mg with10.5 mL Water for Injections to produce a 7.2 mg/mLsolution; mix gently to dissolve; dilute requisite doseto a final concentration not exceeding 500 micrograms/mLwith Sodium Chloride 0.9%; give over 60minutes; incompatible with glucose solutionsCancidas c (MSD) AIntravenous infusion, powder for reconstitution,caspofungin (as acetate), net price 50-mg vial =£327.67; 70-mg vial = £416.78MICAFUNGINCautions monitor renal function; interactions:Appendix 1 (micafungin)Hepatotoxicity Potentially life-threatening hepatotoxicityreported. Monitor liver function—discontinue if significantand persistent abnormalities in liver function tests develop.Use with caution in hepatic impairment (avoid if severe) or ifreceiving other hepatotoxic drugs. Risk of hepatic sideeffectsgreater in children under 1 year of ageHepatic impairment use with caution in mild tomoderate impairment; avoid in severe impairment;see also Hepatotoxicity aboveRenal impairment use with caution; deterioration inrenal functionPregnancy manufacturer advises avoid unless essential—toxicityin animal studiesBreast-feeding manufacturer advises use only ifpotential benefit outweighs risk—present in milk inanimal studiesSide-effects nausea, vomiting, diarrhoea, abdominalpain, hepatomegaly; blood pressure changes, tachycardia;headache, fever; hypokalaemia, hypomagnesaemia,hypocalcaemia, leucopenia, anaemia, thrombocytopenia,renal failure; rash, phlebitis; lesscommonly dyspepsia, constipation, hepatitis andcholestasis (see also Hepatotoxicity above), tastedisturbances, anorexia, palpitation, bradycardia,flushing, dyspnoea, sleep disturbances, anxiety, confusion,dizziness, tremor, pancytopenia, eosinophilia,hyponatraemia, hyperkalaemia, hypophosphataemia,hyperhidrosis, and pruritus; rarely haemolytic anaemiaIndication and doseInvasive candidiasis. By intravenous infusionNeonate 2 mg/kg once daily (increased to 4 mg/kg daily if inadequate response) for at least 14 daysChild 1 month–18 years, body-weight under40 kg 2 mg/kg once daily (increased to 4 mg/kgdaily if inadequate response) for at least 14 daysChild 1 month–18 years, body-weight over40 kg 100 mg once daily (increased to 200 mgdaily if inadequate response) for at least 14 daysOesophageal candidiasis. By intravenous infusionChild 16–18 years, body-weight under 40 kg3 mg/kg once dailyChild 16–18 years, body-weight over 40 kg150 mg once dailyProphylaxis of candidiasis in children undergoingbone-marrow transplantation or who areexpected to become neutropenic for over 10days. By intravenous infusionNeonate 1 mg/kg once daily; continue for at least7 days after neutrophil count in desirable rangeChild 1 month–18 years, body-weight under40 kg 1 mg/kg once daily; continue for at least 7days after neutrophil count in desirable rangeChild 1 month–18 years, body-weight over40 kg 50 mg once daily; continue for at least 7days after neutrophil count in desirable rangeAdministration for intravenous infusion reconstituteeach vial with 5 mL Glucose 5% or Sodium Chloride0.9%; gently rotate vial, without shaking, to dissolve;dilute requisite dose to a concentration of 0.5–2 mg/mL with Glucose 5% or Sodium Chloride 0.9%; protectinfusion from light; give over 60 minutes5 Infections