Spectrum: Local Antimicrobial Stewardship, for Alberta Children's Hospital

Micafungin

C. diff Risk

Low

Oral Bioavailability

NA

Approximate Cost

$100/day

Spectrum Of Activity

General Spectrum of Activity

Spectrum Of Activity

Dosing

Renal

No dosage adjustment required in patients with renal impairment.

Hepatic

No dosage adjustment needed in patients with mild-to-moderate hepatic impairment; the effect of severe hepatic impairment on micafungin pharmacokinetics has not been studied

Neonatal

General Pediatric

Aspergillosis, Esophageal Candidiasis: Usual dose IV: 1.5-3 mg/kg/DAY given as a single daily dose, doses of 4 - 8.6 mg/kg/DAY have been used; maximum/DOSE 325 mg.

Disseminated Candidiasis: Usual dose IV: 2 mg/kg/DAY given as a single daily dose, doses of 4-10 mg/kg/DAY have been used; maximum dose: 200 mg.

Prophylaxis in Hematopoietic Stem Cell Transplant Recipients: IV: 1.5-3 mg/kg/DAY given as a single daily dose.

Dose recommendation vary based on indication and immun status of patient; refer to alternative references if needed.

IV Severe

Use doses at the higher end of the dosing range for CNS infections due to poor CNS penetration.

General Information

Common Usage

Common Usage

Therapy of suspected and confirmed invasive fungal infections

Drug Monitoring

Drug Monitoring

Periodic liver function tests, renal function tests, CBC with differential

Adverse Effects

Adverse Effects

Increased liver enzymes, elevated bilirubin

GI upset

Anemia, pruritis, fever (most common in pediatrics)

Major Interactions

Major Interactions

Increases levels of sirolimus

Pharmacology

Pharmacology

Antimicrobial class: Echinocandin

Average serum half life:

  • Neonates: PNA <1week: 6.7 hours. PNA >3 weeks: 5.6-11 hours.

  • Pediatrics: ≤30 kg: 12.5 ± 4.6 hours. >30kg: 13.6 ± 8.8 hours

  • Healthy adults: 11-21 hours

Route of Elimination: <1% of dose is eliminated unchanged in the urine. 71% is eliminated in the feces