Micafungin is the newest member of the echinocandin group of antifungals. A selective inhibitor of 1,3-β-D-glucan synthase, it is fungicidal against most Candida species and fungistatic against Aspergillus species.

Micafungin is indicated for the treatment of invasive candidiasis and oesophageal candidiasis; and also for the prophylaxis of candidal infections in patients undergoing stem cell transplantation or patients expected to have neutropenia for ten days or more. Invasive candidiasis has a high morbidity and mortality rate, however this may be reduced by timely initiation of appropriate antifungal therapy. Micafungin demonstrates comparable efficacy to liposomal amphotericin B, fluconazole and caspofungin. Despite relatively high acquisition costs, studies highlight potential cost-saving benefits due to reduced length of hospital stay and occurrence of severe complications.

Micafungin has a low potential for medication interactions, can be administered once daily, and does not require dosage adjustment in severe renal or hepatic impairment. Unlike other echinocandins, micafungin vials do not need to be refrigerated.

The most common side effects noted in clinical trials include diarrhoea, nausea, vomiting, pyrexia, thrombocytopenia, and headache. Infusion is recommended to occur over one hour to reduce the risk of histamine-mediated reactions, such as facial flushing, angioedema and bronchospasm. Hypersensitivity to other echinocandins precludes the use of micafungin.

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