Echinocandins in Pediatric Invasive Candidiasis and the Challenges of Antifungal Use in Children

In pediatric invasive candidiasis (IC), epidemiology and risk factors differ compared to adults [1]. Furthermore, the use of antifungals in children is challenging and requires consideration of availability and tolerability of formulations, pharmacokinetic and pharmacodynamic variations, and safety in different age groups [2]. For treatment of IC, while there have been multiple randomized controlled trials (RCT) demonstrating the superiority of echinocandins as initial therapy in adults [3], to date, pediatric data have been limited. The multinational prospective observational Pediatric Antifungal Comparative Effectiveness (PEACE) study by Fisher et al published in this issue provides important data to address this evidence gap [4]. Across 43 international Pediatric Fungal Network sites over 4 years, the PEACE study included 541 participants (aged 4 months to 18 years) with IC (excluding central nervous system [CNS] infection): 235 received initial directed treatment with an echinocandin, 306 with a...