Micafungin Dosing for Clavispora (Candida) Candidemia
For adult patients with Clavispora (formerly Candida lusitaniae) candidemia, administer micafungin 100 mg IV once daily, which is the standard echinocandin dose recommended for all candidemia and invasive candidiasis. 1
Standard Dosing Regimen
- Micafungin 100 mg IV once daily is the recommended dose for treatment of candidemia and invasive candidiasis in adults 1, 2
- This dose applies regardless of renal function, as no dose adjustment is required for renal impairment, including severe renal dysfunction (creatinine clearance <30 mL/min) or patients on hemodialysis 3
- No dose adjustment is needed for hepatic impairment, even in severe hepatic dysfunction (Child-Pugh score 10-12) 3
Treatment Duration and Monitoring
- Continue therapy for at least 2 weeks after documented clearance of Candida from the bloodstream AND resolution of all symptoms attributable to candidemia 1, 4
- Obtain follow-up blood cultures daily or every other day to establish the timepoint of bloodstream clearance 1
- Perform dilated funduscopic examination within the first week after diagnosis to rule out endophthalmitis 1, 5
Critical Management Considerations
- Remove central venous catheters as early as possible when the catheter is the presumed source and can be safely removed 1, 4
- Failure to remove CVCs is associated with worse outcomes and represents a common management pitfall 4
Special Populations
Neutropenic Patients
- Micafungin 100 mg IV once daily remains the standard dose for neutropenic patients with candidemia 1, 2
- Continue treatment for at least 2 weeks after bloodstream clearance AND resolution of both neutropenia and symptoms 2
Critically Ill Patients
- Micafungin 100 mg IV daily is appropriate for severe sepsis with candidemia 5
- All echinocandins (micafungin, caspofungin, anidulafungin) are considered equally effective 4, 6
Higher Dose Considerations
- Micafungin 150 mg IV daily is reserved specifically for esophageal candidiasis, particularly fluconazole-refractory cases 2, 5
- The 150 mg dose is NOT routinely recommended for candidemia, as the 100 mg dose has demonstrated non-inferiority to caspofungin and comparable outcomes 6, 7
- Some retrospective data suggest doses ≥2.25 mg/kg/day may accelerate clinical response, but this does not translate to improved mortality 8
Species-Specific Considerations for Clavispora
While the guidelines do not specifically address Clavispora lusitaniae (now reclassified from Candida lusitaniae), the standard echinocandin dose applies to all Candida species candidemia 1. Clavispora is notable for potential amphotericin B resistance, making echinocandins like micafungin an excellent first-line choice 1.
Common Pitfalls to Avoid
- Do not delay therapy while awaiting species identification—mortality approaches 100% in septic shock without prompt antifungal therapy 5
- Do not prematurely switch to fluconazole before confirming species susceptibility, especially in critically ill patients 4
- Do not discontinue therapy before completing at least 2 weeks after blood culture clearance—premature discontinuation leads to relapse 5, 4
- Do not overlook ophthalmologic examination—endophthalmitis can occur and requires detection 1, 5