Micafungin is an echinocandin that inhibits the synthesis of 1,3-b-D glucan, an essential cell wall component of Candida species. Micafungin, at a dosage of 100 mg daily, has been shown to be as efficacious as liposomal amphotericin B and caspofungin for the treatment of candidemia and invasive candidiasis. It is one of three echinocandins that are recommended in the Infectious Diseases Society of America guidelines for management of candidiasis as first-line therapy for candidemia. Several randomized blinded treatment trials have shown that micafungin, at a dosage of 150 mg daily, is as efficacious as fluconazole for esophageal candidiasis in patients with AIDS. For prophylaxis in the immediate post stem cell transplantation period, micafungin, 50 mg daily, has been reported to prevent invasive candidiasis and diminish the risk for the development of aspergillosis. Micafungin has a very favorable safety profile with few adverse events and minimal drug-drug interactions.
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