Background Medical advances have resulted in more children susceptible to infections with Candida and Aspergillus; limited information on new therapies is available on children.

Methods Meta-analysis from six trials.

Results 296 children received micafungin for invasive candidiasis (IC), refractory IC, refractory invasive aspergillosis (IA) or prophylaxis in haematopoietic stem cell transplantation (HSCT) patients or to assess pharmacokinetics. The majority of infants (<1 year) had premature birth as an underlying condition (38/66), and the majority of older children were HSCT recipients or were undergoing another therapy for a haematological malignancy (181/230). The maximum daily dose was similar for patients <1, 1–4, 5–8, 9–12 and 13–15 years of age with medians of 2.0, 1.5, 1.5, 1.9 and 1.5 mg/kg, respectively. High treatment success rates were observed for all indications (see table). Micafungin showed linear pharmacokinetics, with a higher clearance rate in neonates than in older children and adults. In this critically ill population, common events were transient increases in transaminases, hypokalaemia, hyperbilirubinaemia and increased alkaline phosphatase (2–3% of children), with no meaningful differences between adults and children.

Conclusion Micafungin was shown to be an effective and well-tolerated therapy for IC, refractory IA, empirical therapy and prophylaxis in children, with linear and predictable pharmacokinetics.