Micafungine

Intravenous micafungin is an echinocandin antifungal agent, its mode of action is the inhibition of synthesis of 1,3-β-d-glucan, an essential cell wall component in many fungi. It is active in vitro against all Candida spp. and against Aspergillus spp. In large randomized clinical trials, micafungin was shown effective in oesophageal candidiasis and non inferior to fluconazole, in candidemia and invasive candidiasis and non inferior to liposomal amphotericin B or caspofungin and as prophylactic treatment of fungal infections in hematopoietic stem cell transplant recipients, superior to fluconazole. Efficacy was demonstrated in paediatric patients including neonates and premature children. Efficacy was established against invasive aspergillosis in non-randomized clinical trials. Tolerance was satisfactory, similar to fluconazole or caspofungin and better than liposomal amphotericin B. Drug-drug interactions are mild and limited (sirolimus, itraconazole and nifédipine).