Micafungin

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Abstract
▴ Micafungin, an echinocandin antifungal agent with a novel mechanism of action, inhibits β-(l,3)-D-glucan synthase interfering with fungal cell wall synthesis. It shows excellent antifungal activity against a broad range of Candida spp., including azole-resistant strains, and Aspergillus spp. in in vitro and animal studies. ▴ In HIV-positive patients, intravenous micafungin 50–150 mg/day dose-dependently eradicated endoscopically confirmed oesophageal candidiasis, with micafungin 100 and 150 mg/day being more effective than micafungin 50 mg/day and as effective as fluconazole 200 mg/day in a double-blind trial. ▴ In nonblind trials, micafungin (monotherapy or combination therapy) was effective against invasive aspergillosis, candidiasis and candidaemia in paediatric and adult patients with newly diagnosed or refractory infections. ▴ Micafungin 50 mg/day provided significantly better antifungal prophylaxis than fluconazole 400 mg/ day in 882 haematopoietic stem cell transplant recipients in a randomised, double-blind trial. Respective overall success rates were 80% and 73.5%. ▴ Micafungin is generally well tolerated. Adverse events were not dose- or infusion-related with micafungin 12.5–900 mg/day; no histamine-like reactions occurred. Micafungin was as well tolerated as fluconazole, with numerically fewer micafungin recipients discontinuing treatment (4.2% vs 7.2%).