Micafungin 50 mg IV Daily Dosing Indications
Micafungin 50 mg IV daily is specifically indicated for prophylaxis of Candida infections in hematopoietic stem cell transplant (HSCT) recipients, not for treatment of active invasive candidiasis. 1, 2
Primary Indication: HSCT Prophylaxis
- The FDA-approved dose for prophylaxis in HSCT recipients is 50 mg IV once daily in adults, initiated after the last dose of chemotherapy and continued until neutrophil recovery 2
- The Infectious Diseases Society of America (IDSA) 2009 guidelines recommend micafungin 50 mg daily as prophylaxis during the period of neutropenia risk in stem cell transplant recipients (strong recommendation; high-quality evidence) 3
- In the pivotal trial of 882 HSCT recipients, micafungin 50 mg daily achieved 80.7% prophylactic success compared to 73.7% with fluconazole 400 mg daily, with a mean treatment duration of 19 days 2
Why NOT 50 mg for Treatment of Invasive Candidiasis
For treatment of candidemia, acute disseminated candidiasis, or other invasive Candida infections, the standard dose is 100 mg IV daily, not 50 mg. 3, 1, 2
Treatment Dosing by Indication:
- Invasive candidiasis/candidemia: 100 mg IV daily (strong recommendation; moderate-quality evidence) 3, 1, 2
- Esophageal candidiasis: 150 mg IV daily 1, 2
- Chronic disseminated candidiasis: 100 mg IV daily for several weeks 3
Pediatric Dosing Considerations
- For HSCT prophylaxis in pediatric patients ≥4 months: 1 mg/kg IV once daily (maximum 50 mg) 1, 2
- For treatment of invasive candidiasis in pediatric patients: 2 mg/kg IV once daily (maximum 100 mg) 1, 2
Common Pitfall to Avoid
The most critical error is using the 50 mg prophylactic dose to treat active invasive candidiasis. This underdosing can lead to treatment failure and increased mortality, as the standard treatment dose is 100 mg daily for invasive infections 3, 1, 2. The 50 mg dose has only been validated for prophylaxis in the HSCT setting, where patients do not have active fungal infection 2, 4.