Initial therapy for candidaemia in children

In children with candidaemia, if initial echinocandin therapy is indicated, useKeighley, 2021:

1micafungin intravenously; see advice on continuation therapy for candidaemia and duration of therapy for candidaemia micafungin

child less than 40 kg: 2 mg/kg up to 100 mg daily1

child 40 kg or more: 100 mg daily2

OR

1caspofungin intravenously; see advice on continuation therapy for candidaemia and duration of therapy for candidaemia3 caspofungin

child younger than 3 months: 25 mg/m2 daily

child 3 months or older: 70 mg/m2 up to 70 mg for the first dose, then 50 mg/m2 up to 70 mg daily4

OR

2anidulafungin 3 mg/kg up to 200 mg intravenously, for the first dose, then 1.5 mg/kg up to 100 mg daily. See advice on continuation therapy for candidaemia and duration of therapy for candidaemia. anidulafungin

Initial fluconazole therapy may be an alternative to an echinocandin in children who are not critically ill – seek expert advice from an infectious diseases physician or clinical microbiologist.

A lipid formulation of amphotericin B is an alternative if there is resistance or intolerance to other antifungals – seek expert advice.

For advice on choosing an antifungal for candidaemia in neonates, see Initial therapy for candidaemia in neonates.

1 For children weighing less than 40 kg, if response to treatment is inadequate, increase the micafungin dose to 4 mg/kg up to 150 mg daily.Return
2 For children weighing 40 kg or more, if response to treatment is inadequate, increase the micafungin dose to 200 mg daily.Return
3 Use the online calculator to determine body surface area.Return
4 If treatment is well tolerated but response is inadequate, increase the caspofungin maintenance dose to 70 mg/m2 up to 70 mg daily.Return