Caspofungin for Candida Endocarditis

To The Editors: Fungal endocarditis in immunocompetent children is infrequent but can be a fatal complication after cardiac surgery. It is usually refractory to conventional medical therapy, which can be toxic especially in neonates and infants. However, the progress in development of antifungal agents can create new therapeutic modalities for this group. We report a 2-month-old infant with multiorgan congenital malformations who developed fungal endocarditis and sepsis after the correction of a ventricular septal defect. The patient was readmitted to our pediatric center in August 2002 and received amphotericin B. However, this treatment was unsuccessful because of isolation of amphotericin B-resistant Candida glabrata (resistant also to fluconazole) in consecutive blood cultures. Because of progressive deterioration of the patient’s condition, all prosthetic materials (patch and the felt pledgets) were removed, and a tricuspid valve-sparing debridement was performed. The ventricular septal defect was closed by direct suture. Additionally caspofungin therapy was begun. Because of the absence of guidelines for the drug use in children, we administered a single loading dose of 5 mg/kg, followed by a maintenance dose of 3 mg/kg daily for 6 weeks. Consecutive cultures were free from Candida strains. No long term nephro- or hepatotoxicity was observed. The patient’s recovery was uneventful. Our patient’s severe Candida endocarditis was treated effectively and safely with caspofungin therapy. There are few studies describing the use of echinocandins in children. 1–3 Our findings are consistent with the results of these articles on caspofungin. Wojciech Mrówczyński, M.D., Ph.D. Michal Wojtalik, M.D., Ph.D.