Micafungin
Mechanism :
It is an echinocandin with concentration-dependent inhibition of 1,3-beta-D-glucan synthase resulting in reduced formation of 1,3-beta-D-glucan, an essential polysaccharide comprising 30% to 60% of Candida cell walls.
Indication :
- Esophageal candidiasis
- Treatment of candidemia, acute disseminated candidiasis, Candida peritonitis and abscesses
- Prophylaxis of Candida infections
Contraindications :
Hypersensitivity to micafungin, other echinocandins, or any component of the formulation.
Dosing :
Candidemia, acute disseminated candidiasis, and Candida peritonitis and abscesses:
Premature Neonates >1000 g and Term Neonates: Limited data are avaible
7 to 10 mg/kg/dose IV once daily.
Doses of 10 to 15 mg/kg/dose IV once daily have been used successfully in the setting of CNS infections.
Premature Neonates <1000 g: Limited data are avaible
10 mg/kg/dose IV once daily
1-3 months:
2 mg/kg IV OD. If there is an inadequate clinical response after 5 days, may increase dose to 4 mg/kg/day.
≥4 months:
2 mg/kg IV OD; (Maximum: 100 mg once daily in children <40 kg and 200 mg/day in >40 kg). If there is an inadequate clinical response after 5 days, may increase dose to 4 mg/kg/day.
Duration: At least 14 days after resolution of symptoms or last positive culture, whichever is longer.
Esophageal candidiasis:
1-3 months:
5 to 7 mg/kg/dose IV once daily for 14 to 21 days.
>4 months, ≤30 kg:
3 mg/kg once daily for 14 to 21 days.
>4 months, >30 kg:
2.5 mg/kg once daily; maximum: 150 mg once daily for 14 to 21 days.
Prophylaxis of Candida infection in hematopoietic stem cell transplantation:
1 mg/kg once daily; maximum: 50 mg once daily for 6 weeks.
Adverse Effect :
Abdominal pain, Anemia, Headache, Diarrhea, Increased transaminases, Leukopenia, Nausea Neutropenia, Phlebitis, Pruritus, Pyrexia, Rash, Rigors, Thrombocytopenia, Vomiting, Facial swelling, Vasodilation, Stevens-Johnson syndrome, toxic epidermal necrolysis, shock.
Interaction :
Sirolimus: Micafungin may increase the serum concentration of Sirolimus.
Saccharomyces boulardii: Antifungal Agents may diminish the therapeutic effect of Saccharomyces boulardii.
Hepatic Dose :
No dosage adjustments are recommended.