Commentary
Micafungin belongs to echinocandins. It is a semisynthetic lipopeptite
and exerts its antifungal effects by inhibiting the synthesis of
1,3-β-D-glucan, an essential component of the cell walls of certain fungi,
which is absent from mammalian cells. Its FDA indications include treatment
of candidemia, acute disseminated candidiasis, Candida peritonitis and
abscesses while treatment has not been adequately studied in endocarditis,
osteomyelitis and meningitis caused by Candida. Additionally, it is
indicated for the treatment of esophageal candidiasis and prophylaxis of
Candida infections in patients undergoing hematopoietic stem cell
transplantation
Micafungin is fungicidal against most Candida spp., including azole-resistant
Candida, and Aspergillus flavus. However, it is less active against
C. parapsilosis, C. lusitaniae, and C. guilliermondii species. Although
micafungin is active against the cyst form of Pneumocystis jiroveci, it has
no direct effect on trophozoite proliferation. It has no activity
against Cryptococcus neoformans, Trichosporon spp., Zygomycetes, and
Fusarium
spp..
In adult patients with invasive candidiasis, micafungin is noninferior to
caspofungin or liposomal amphotericin B. Likewise, in adult patients with
esophageal candidiasis, micafungin is noninferior to caspofungin or
fluconazole. As for antifungal prophylaxis for heamopoietic stem cell
transplant recipients, micafungin is superior to fluconazole. Micafungin is
generally well tolerated as caspofungin and fluconazole, and is associated
with less infusion-related reaction than liposomal amphotericin B.
Nevertheless, micafungin is less expensive than caspofungin and liposomal
amphotericin B.
No significant drug-drug interactions between micafungin and mycophenolate,
cyclosporine, tacrolimus, prednisolone, fluconazole, voriconazole,
amphotericin B, ritonavir, and rifampin. However, area under curve of
sirolimus, nifedipine or itraconazole was increased in combination with
micafungin. Close monitoring and dose adjustment if indicated are suggested.
Clinical Studies
At the dose of 150 mg/day, micafungin demonstrated its safety and efficacy as the empirical antifungal therapy of febrile neutropenia in patients with hematological malignancies.
Micafungin was well tolerated and is a reasonable option for treatment of invasive aspergillosis in this high-risk patient population
Micafungin appears to be as effective and as safe as liposomal amphotericin B for the treatment of invasive candidiasis in pediatric patients.
Review Articles
Pediatric data regarding the employment of micafungin were reviewed with focus on pharmacokinetics, efficacy, and safety.
In this review, not only are the microbial effects of antifungal effects discussed but also its interaction with the immunity of the host.
This is an updated review of pharmacological profile and clinical efficacy of micafungin for the treatment of invasive and oesophageal candidiasis in adults, and as prophylaxis against Candida infections.
The unique advantages of caspofungin, micafungin, and anidulafungin for clinician are highlighted.
Adverse Drug Reactions and Warnings
FDA Information
Manufacturer/Distributor Product Information