[Pharmacodynamics and pharmacokinetics of micafungin in adults, children and neonate].
BACKGROUND
Invasive fungal infections are a significant cause of morbidity and mortality among immunocompromised patients. Although several new antifungal agents have been developed in the past few years, the management of serious fungal infections continues to be problematic.


OBJECTIVE
To review the pharmacodynamics and pharmacokinetics of a new antifungal agent: micafungin.


METHODS
A systematic review of biomedic databases (EBSCO Open Journals, Ovid Online, Proquest Medical Library, PubMed/Medline, Science Direct, Springer Links and Wiley Interscience) has been performed. Search was conducted from 2000 to 2008. Supplementary sources included abstracts from the Interscience Conference on Antimicrobial Agents (ICAAC) and Chemotherapy and the Infectious Diseases Society of America (IDSA) from 1998 to 2008.


RESULTS
Micafungin has a potent mechanism of action: inhibits beta-1,3-D-glucan synthase interfering with fungal cell wall synthesis. This agent shares with caspofungin an identical spectrum of in vitro activity against Candida albicans, non-albicans Candida species, and Aspergillus. Due to the limited oral availability, micafungin is available for parenteral administration only. Micafungin is characterized by a linear pharmacokinetic profile and substantially fewer toxic effects. Micafungin is a poor substrate for the cytochrome P450 enzymes, and compared to azoles, fewer drug interactions have been described. No dose reduction is required in renal impairment or in mild to moderate liver failure.


CONCLUSIONS
The pharmacodynamic and pharmacokinetic profiles of micafungin imply that this drug is a safe alternative for the treatment of fungal infections. Micafungin can be safely co-administered with most drugs without the need for dosage adaptation even in patients with renal o liver function impairment.
Catalán-González
Mercedes
M
Servicio de Medicina Intensiva, UCI-Polivalente, Hospital Universitario 12 de Octubre, Madrid, España. mmcges@yahoo.es
Carlos Montejo-González
Juan
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D000935:Antifungal Agents / Q000009:adverse effects / Q000493:pharmacokinetics / Q000494:pharmacology* / Q000627:therapeutic use; D001230:Aspergillus / Q000187:drug effects / Q000201:enzymology; D001711:Biotransformation; D002175:Candida / Q000187:drug effects / Q000201:enzymology; D002648:Child; D002675:Child, Preschool; D004353:Drug Evaluation, Preclinical; D004347:Drug Interactions; D054714:Echinocandins / Q000009:adverse effects / Q000493:pharmacokinetics / Q000494:pharmacology* / Q000627:therapeutic use; D005656:Fungal Proteins / Q000037:antagonists & inhibitors*; D005964:Glucosyltransferases / Q000037:antagonists & inhibitors*; D006801:Humans; D007231:Infant, Newborn; D055666:Lipopeptides / Q000009:adverse effects / Q000493:pharmacokinetics / Q000494:pharmacology* / Q000627:therapeutic use; D000077551:Micafungin; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D015394:Molecular Structure; D009181:Mycoses / Q000188:drug therapy*; D045363:Pneumocystis carinii / Q000187:drug effects / Q000201:enzymology; D055815:Young Adult
D000935:Antifungal Agents; D054714:Echinocandins; D005656:Fungal Proteins; D055666:Lipopeptides; D005964:Glucosyltransferases; C020570:1,3-beta-glucan synthase; D000077551:Micafungin