Monitoring and use of antimycotic (micafungin) for systemic use provided by the pharmacy of Marsala Hospital, Italy

Micafungin is an antimycotic drug and represents an important addition to the available therapies for the treatment of systemic fungal infections. Micafungin is used: in the treatment of invasive candidiasis, oesophageal and prophylaxis of Candida infections. It inhibits, in a non-competitive way, the synthesis of 1,3-β-D-glucan, a component of fungal cell wall and is rapidly distributed into the tissues. It has a high-rate respectful bond with plasma protein, which is independent from the concentration of the drug. It is metabolized through the liver, being not subject to intense metabolic transformations until the excretion. There is no evidence of systemic accumulation after repeated use. The steady-state is reached in 4-5 days. Medical records examined at the pharmacy of Marsala Hospital highlight that, from 01/06/2014 to 01/08/2014, in this hospital 12 vials were used by the hospitalized patients in the Department of Intensive Care: 8 patients between 75 and 83 years old had a body weight (BW) higher than 40 kg; 3 patients between 40 and 60 years of age had a BW higher than 40 kg, and one 17 year-old patient had a BW of 40 kg. Two patients needed a dose increase, while for the other 10 patients the first dose resulted sufficient. Mycamine^® was used for the treatment of hypovolemic post-operative shock. The most recorded adverse reactions were anemia, hypokalemia, hypomagnesemia, phlebitis, nausea, liver problems. Given the different weight of the subjects, the dosage was different.