Introduction
Invasive candidemia and Candida meningoencephalitis are significant causes of morbidity and mortality in premature neonates and critically ill or immunocompromised pediatric patients. The incidence of candidemia ranges from 2 to 10 cases per 100,000 subjects in surveillance studies of both adults and children, with a mortality rate of 5–10%. The echinocandins (caspofungin, micafungin, and anidulafungin) have become important options for the treatment of these infections. Micafungin, the second drug in this class to be developed, was approved by the Food and Drug Administration in 2005 for use in adults. It offers the advantages of once daily dosing, a low degree of resistance, and a relatively mild adverse effect profile. Shortly after approval micafungin began to be used in children with resistant fungal infections and in those who were unable to tolerate the adverse effects of other agents. On June 21, 2013, the FDA extended approval to use in children 4 months of age and older. While not yet approved for infants, recent studies have shown benefit in this patient population with the use of higher weight-based doses to account for a more rapid drug clearance.