Micafungin

Mycamine

Micafungin is an echinocandin antifungal, a cyclic lipopeptide that kills fungi by blocking the enzyme β-(1,3)-D-glucan synthase and thereby preventing construction of the fungal cell wall. Like the rest of its class, it exploits a target present only in fungi, giving it selective activity and generally good tolerability compared with older antifungal drugs. Micafungin is administered by intravenous infusion. Its approved uses include the treatment of candidemia and other invasive Candida infections (such as intra-abdominal abscesses and peritonitis), esophageal candidiasis, and — a use for which it is particularly well established — prophylaxis against Candida infections in patients undergoing hematopoietic stem-cell transplantation, who are at high risk while their immune system recovers. It is fungicidal against many Candida species. Among the echinocandins, micafungin is valued for not requiring dose adjustment for kidney impairment and generally not needing adjustment for mild-to-moderate liver impairment, and for having relatively few drug interactions. As with the whole class, it is given only intravenously, penetrates the central nervous system and urine poorly, and is used for serious infections rather than superficial ones. Micafungin is a prescription hospital medicine used under specialist guidance; it is not an over-the-counter or topical antifungal.