Dosing: Adult Antimicrobial Dosing, Non-dialysis
| Indication | Dose | Notes |
|---|---|---|
| Candidemia Invasive candidiasis Empiric treatment, febrile neutropenia Empiric treatment, non-neutropenic ICU patients | 100 mg IV q24h* | Dosage adjustment not required in renal or hepatic dysfunction |
| Esophageal candidiasis Infective endocarditis Cardiac device-associated infections | 150 mg IV q24h | |
| Prophylaxis against Candida in patients with HSCT, neutropenia, hematologic malignancy, or solid organ transplant^ | 50-100 mg IV q24h |
*Higher doses may be utilized for select deep-seated infections, elevated MICs, and/or patients with obesity. Contact ID/ASP for assistance.
^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 |
|---|---|---|
| Candidemia Invasive candidiasis Empiric treatment, febrile neutropenia Empiric treatment, non-neutropenic ICU patients | 100 mg IV q24h* | Dosage adjustment not required in renal or hepatic dysfunction |
| Esophageal candidiasis Infective endocarditis Cardiac device-associated infections | 150 mg IV q24h | |
| Prophylaxis against Candida in patients with HSCT, neutropenia, hematologic malignancy, or solid organ transplant^ | 50-100 mg IV q24h |
*Higher doses may be utilized for select deep-seated infections, elevated MICs, and/or patients with obesity. Contact ID/ASP for assistance.
^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
Dialysis Notes
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