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Dosing: Adult Antimicrobial Dosing, Non-dialysis
| Indication | Dose | Notes |
|---|---|---|
| Esophageal candidiasis | 150 mg IV daily |
Dosage adjustment not required in renal or hepatic dysfunction |
| *Prophylaxis against Candida in patients with HSCT, neutropenia, hematologic malignancy, or solid organ transplant | 50-100 mg IV daily | |
|
Candidemia Invasive candidiasis Empiric treatment, febrile neutropenia Empiric treatment, non-neutropenic ICU patients |
100 mg IV daily |
* If patient does not have a drug interaction with an azole, but needs micafungin as prophylaxis, these are the lab thresholds: AST or ALT > 3x ULN + new symptoms OR AST or ALT >5 x ULN OR T bilirubin ≥ 3 mg/dL
Dosing: Antimicrobial Dosing in Intermittent & Continuous Hemodialysis
| Indication | Dose | Notes |
|---|---|---|
| Esophageal candidiasis | 150 mg IV daily |
Dosage adjustment not required in hemodialysis |
| *Prophylaxis against Candida in patients with HSCT, neutropenia, hematologic malignancy, or solid organ transplant | 50-100 mg IV daily | |
|
Candidemia Invasive candidiasis Empiric treatment, febrile neutropenia Empiric treatment, non-neutropenic ICU patients |
100 mg IV daily |
* Micafungin can be used as an alternative to azole prophylaxis in the setting of drug interaction or hepatotoxicity beyond these lab thresholds: AST or ALT > 3x ULN with new symptoms OR AST or ALT >5 x ULN OR T bilirubin ≥ 3 mg/dL
Dialysis Notes
Intermittent HD assumes high-flux hemodialysis. CRRT assumes CVVHD with ultrafiltration rate 2L/h and residual native GFR < 10 mL/min. For detailed view of dialysis dosing and evidence, see Dosing in Hemodialysis document.
Restricted to ID or Antimicrobial Stewardship except:
1) Documented sterile site (not urine or respiratory) infection with microbiologically confirmed Candida spp (ID/ASP approval required for durations exceeding 48h)
2) Documented sterile site infection (not urine or respiratory) infection with yeast, pending species identification (ID/ASP approval required for durations exceeding 48h)
3) Prophylaxis against fungal infections in patients on the hematology/oncology/BMT service with intolerance of or contraindications to azoles
4) Empiric therapy for prolonged febrile neutropenia in hematology/oncology/BMT patient