Antimicrobials
Micafungin

Micafungin

Low
N/A
$$$

Spectrum of Activity

General Information

Aspergillosis

  • Infusional toxicity or acute renal failure on ABLC and intolerance to voriconazole defined as serious hepatotoxicity, persistent visual disturbance, or allergic reaction
  • Refractory disease for use in combination with voriconazole or ABLC for definite or probable invasive pulmonary aspergillosis in patients who are refractory to voriconazole or ABLC alone (ID consult advised)

Candidiasis

  • Treatment of invasive candidiasis due to C. glabrata or C. krusei
  • Treatment of invasive candidiasis in patients who are NOT clinically stable due to candidemia or have received prior long-term azole therapy
  • Alternative treatment of recurrent esophageal candidiasis
  • Alternative treatment of endocarditis

Neutropenic Fever

  • Micafungin can be used for neutropenic fever in patients who are not suspected to have aspergillosis or zygomycosis

Aspergillosis

  • Micafungin alone or in combination with other antifungal agents is not recommended for empiric therapy in patients with CT findings suggestive of aspergillosis (e.g., possible aspergillosis) without plans for diagnostic studies
  • Micafungin does not have good in vitro activity against zygomycoses (Mucor, Rhizopus, Cunninghamella, etc.)

Candidiasis

  • Micafungin has poor penetration into the CNS and urinary tract. It should be avoided for infections involving those sites. Positive urine cultures for resistant Candida in catheterized patients usually represent colonization and should not be treated with micafungin
  • Monotherapy for zygomycoses (Mucor, Rhizopus, etc.)

Therapy of suspected and confirmed invasive fungal infections, particularly Candidiasis and Aspergillosis

Laboratory

  • CMP and CBC at baseline and every 1-2 weeks
  • Infusion-related reactions (rash, pruritis, fever)
  • Phlebitis
  • Headache
  • Nausea and vomiting
  • Elevations in hepatic enzymes
  • Elevations in BUN and Scr
  • Anemia

Micafungin has poor urinary penetration. It should not be used for treatment of Candida urinary tract infections, with select exceptions. Consult ID for advice.

Antimicrobial class: Echinocandin

Pregnancy category: C

Average serum half life: 11-21 hours

Biliary penetration: Therapeutic

CSF penetration: Poor

Lung penetration: Therapeutic

Urine penetration: Poor