Australia’s third echinocandin has been registered to treat invasive, or oesophageal, candidiasis, and for prophylaxis against Candida in patients expected to have neutropenia for 10 or more days.

FDA approved product information states that Mycamine® (micafungin) inhibits fungal cell wall synthesis using a semisynthetic lipopeptide derived from the defence armament of another fungus. Efficacy has not been established for micafungin in treating endocarditis, osteomyelitis, meningitis, or fungal infections other than Candida.

Dosing adjustment is not needed for race, gender, severe renal impairment, hepatic impairment, or other medicines. Concomitant sirolimus, itraconazole or nifedipine may need dose reduction and should be monitored for toxicity.

Over 90% of patients experience adverse events to the once daily infusion, including hypersensitivity and haemolytic reactions, Steven-Johnson’s syndrome and damage to liver and kidneys. Micafungin may however be safer, and better tolerated, than other available treatments
for these conditions with very high morbidity and mortality.

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