Micafungin Dosing and Administration Protocol
The recommended dose of micafungin for adults is 100 mg daily administered intravenously for treatment of candidemia and invasive candidiasis, with higher doses of 150 mg daily for esophageal candidiasis, and 50 mg daily for prophylaxis. 1, 2
Adult Dosing
Treatment of Candidemia and Invasive Candidiasis
- 100 mg intravenously once daily 1
- Duration: Continue for at least 2 weeks after documented clearance of Candida from the bloodstream and resolution of symptoms 1
- For fluconazole-refractory esophageal candidiasis, micafungin 150 mg daily is recommended 1
Prophylaxis
- 50 mg intravenously once daily for prophylaxis in hematopoietic stem cell transplant recipients 1
- Studies show micafungin 50 mg/day provides significantly better antifungal prophylaxis than fluconazole 400 mg/day in hematopoietic stem cell transplant recipients 3
Pediatric Dosing
Children ≥4 months of age
- Treatment of candidemia/invasive candidiasis: 2 mg/kg once daily (maximum 100 mg daily) 2
- Treatment of esophageal candidiasis: 3 mg/kg once daily for children ≤30 kg; 2.5 mg/kg once daily (maximum 150 mg daily) for children >30 kg 2
- Prophylaxis: 1 mg/kg once daily (maximum 50 mg daily) 2
Neonates and Children <4 months
- For prophylaxis in children 1 year of age: 50 mg/m² per day (day 1,70 mg/m²) intravenously in 1 dose, max 70 mg per day 1
- For children 3-12 months: 50 mg/m² per day 1
- For infants <3 months of age: 25 mg/m² per day 1
Administration Protocol
Reconstitution
- Reconstitute micafungin vials by aseptically adding 5 mL of either 0.9% Sodium Chloride Injection or 5% Dextrose Injection 2
- Gently swirl to dissolve; do not vigorously shake the vial 2
- After reconstitution, 50 mg vial contains 10 mg/mL; 100 mg vial contains 20 mg/mL 2
Dilution
- For adults: Add the appropriate volume of reconstituted micafungin into 100 mL of 0.9% Sodium Chloride Injection or 5% Dextrose Injection 2
- For pediatric patients: Calculate the total dose in mg by multiplying the recommended dose (mg/kg) by the patient's weight (kg) 2
- Ensure the final concentration of the solution is between 0.5 mg/mL to 4 mg/mL 2
Infusion
- Administer by intravenous infusion only 2
- Infuse over one hour to minimize histamine-mediated reactions 2, 3
- Flush existing intravenous lines with 0.9% Sodium Chloride Injection prior to infusion 2
- For concentrations above 1.5 mg/mL, administer via central catheter 2
Storage
- The combined storage time of reconstituted solution in the original vial and diluted solution in the infusion bag should not exceed 12 hours at room temperature (20-25°C) 2
- Protect the reconstituted and diluted solutions from light 2
Special Considerations
- For patients with candidemia, removal of intravenous catheters is strongly recommended when possible, as this improves outcomes 1, 4
- Micafungin has excellent activity against a broad range of Candida species, including azole-resistant strains 3, 4
- Extended dosing intervals (e.g., 300 mg twice weekly) may be considered for outpatient prophylaxis in hematology patients, though this is not yet in standard guidelines 5