Systemic Antifungal Therapy for Invasive Candidiasis in Young Children

First‑Line Systemic Agents

Micafungin administered intravenously at 2–4 mg/kg/day is recommended as a first‑line therapy (strength A‑I). This dosing is appropriate for children with confirmed invasive candidiasis, providing effective fungal clearance. 4
Caspofungin given as a 70 mg/m² loading dose followed by 50 mg/m²/day intravenously is recommended as a first‑line option (strength A‑I). It is suitable for pediatric patients with bloodstream or deep‑tissue Candida infection. 6
Fluconazole 8–12 mg/kg/day, administered intravenously or orally, is advised for hemodynamically stable children who have not been recently exposed to azole agents. This regimen offers a convenient oral step‑down option when the patient is stable. 7

Liposomal amphotericin B at 3 mg/kg/day intravenously is an alternative first‑line agent (strength A‑I) and is associated with lower toxicity in children compared with conventional amphotericin B. It may be chosen when echinocandins are contraindicated or unavailable. 4

Therapy should be continued for at least 14 days after the first negative blood culture and after clinical signs have resolved. This ensures eradication of the pathogen and reduces relapse risk. 8
Indwelling vascular catheters should be removed or replaced whenever feasible during treatment. Catheter removal is a key component of source control in candidemia. 8
All children with candidemia require a comprehensive ophthalmologic examination to detect possible ocular involvement. Early detection allows timely management of end‑ocular disease. 8