Successful Topical Application of a New Antifungal Agent, Micafungin, in the Treatment of Refractory Fungal Corneal Ulcers

Matsumoto, Yukihiro; Doğru, Murat; Goto, Eiki; Fujishima, Hiroshi; Tsubota, Kazuo

doi:10.1097/01.ico.0000154390.28254.54

Cited by 23 publications

(14 citation statements)

References 39 publications

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“…Kaji et al also reported that the treatment with subconjunctival injection of 0.1% MCFG was effective for keratomycosis caused by C albicans in a rabbit model 36. Topical application of 0.1% MCFG was reported to be clinically effective in refractory fungal corneal ulcers caused by C albicans or C parapsilosis 28. All these experimental and clinical observations support the results of this study.…”

Section: Discussionsupporting

confidence: 85%

“…We also previously reported the efficacy of topical MCFG in the treatment of three cases with yeast keratitis who were refractory to topical and/or systemic fluconazole treatment 28. In an effort to clarify which treatment modality (solitary topical MCFG versus solitary topical FCZ) was more effective in Candida keratitis, we compared the clinical outcomes of treatment between the MCFG and FCZ groups in this prospective study.…”

Section: Discussionmentioning

confidence: 99%

“…To our knowledge, there are no retrospective or prospective clinical studies of topical MCFG treatment in fungal keratitis except a case report in the literature28 and ophthalmic studies comparing the efficacy of topical MCFG with FCZ. This study suggested that topical MCFG proved to be similarly effective to topical FCZ in the treatment of Candida fungal keratitis.…”

Section: Discussionmentioning

confidence: 99%

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The comparison of solitary topical micafungin or fluconazole application in the treatment of Candida fungal keratitis

Matsumoto

Doğru

Kojima

et al. 2010

British Journal of Ophthalmology

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The comparison of solitary topical micafungin or fluconazole application in the treatment of Candida fungal keratitis

Matsumoto

Doğru

Kojima

et al. 2010

British Journal of Ophthalmology

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“…A study that compares intravenous micafungin with intravenous caspofungin for candidemia and invasive candidiasis is in progress. An interesting report noted a successful outcome with topical application of micafungin in the treatment of refractory yeast-related corneal ulcers in 3 patients [46].…”

Section: Clinical Efficacymentioning

confidence: 99%

Micafungin: A New Echinocandin

Chandrasekar

Sobel

2006

Clinical Infectious Diseases

223

131

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Micafungin, a potent inhibitor of 1,3-b-D-glucan synthase, has become the second available agent in the echinocandins class that is approved for use in clinical practice. This agent shares with caspofungin an identical spectrum of in vitro activity against Candida albicans, non-albicans species of Candida, and Aspergillus species, as well as several but not all pathogenic molds. If anything, its in vitro activity appears to be superior to that of caspofungin, although the clinical relevance of this observation is unclear. The clinical role of micafungin appears to be similar to that of caspofungin, although clinical data are still lacking at this stage, with initial approval only for treatment of esophageal candidiasis and prophylaxis in subjects with neutropenia. Pharmacokinetic and pharmacodynamic studies and reports of adverse effects and safety have reported similar but not identical results to those of other agents in the echinocandin class. Factors such as acquisition costs and the potential for resistance development may be more relevant to its widespread use than in vitro and in vivo data comparisons with caspofungin.The echinocandins are a novel class of antifungals. Caspofungin was the first echinocandin agent approved by the US Food and Drug Administration (FDA), and anidulafungin is currently in phase 3 development. Micafungin is a promising echinocandin that was recently approved by the FDA and has demonstrated activity against Candida and Aspergillus species. MECHANISM OF ACTIONMicafungin is a water-soluble antifungal agent (molecular weight, 1292.26 Da) that is derived from Coleoptioma empedri via enzymatic cleavage of the hexapeptide FR901370, a natural product of the fungus; the addition of a fatty N-acyl side chain improves its antifungal potency [1,2]. Micafungin acts in a concentration-dependent manner as a noncompetitive inhibitor of the formation of the enzyme 1,3-b-d glucan synthase, an enzyme necessary for synthesis of 1,3-b-d glucan, a glucose polymer crucial to the structure and integrity of the cell wall of several common fungal pathogens [3][4][5]. Fungal cells unable to synthesize this polysaccharide cannot maintain their shape and lack adequate rigidity to resist osmotic pressure, which results in fungal cell lysis. This mechanism is unique to the echinocandin class of antifungal agents and has the potential to be either additive or synergistic with polyenes and azoles. Glucan is essential not only to cell-wall structure and integrity but also to cell growth and division [6]. Micafungin demonstrates a prolonged concentration-dependent postantifungal effect.Most fungal cell walls contain chitin, a-or b-linked glucans, and a variety of mannoproteins, although the quantity and relative importance of each component varies among different fungal species-thus, the selective antifungal effect on echinocandins [7]. Of significance, the cell walls of zygomycetes and cryptococcus lack 1,3-b-d glucan, which explains the poor activity of echinocandins, including micafungin, against these fungi ...

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“…Two other studies involving topical MFG 1 mg/ml found an efficacy comparable or superior to FCZ in the treatment of keratitis by Candida albicans and Candida parapsilosis (124,125) .…”

Section: Echinocandinsmentioning

confidence: 99%

Antifúngicos em infecções oculares: drogas e vias de administração

Müller¹,

Kara‐José²,

Castro³

2013

Rev. bras.oftalmol.

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RESUMOO tratamento das infecções oculares por fungos representa um desafio à prática oftalmológica. Para obtermos resposta terapêutica adequada, além do uso da droga correta, é necessária a administração desta de forma eficaz. Este manuscrito reúne informações a respeito das principais drogas antifúngicas utilizadas em infecções oculares, suas concentrações e principais vias de administração.

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Successful Topical Application of a New Antifungal Agent, Micafungin, in the Treatment of Refractory Fungal Corneal Ulcers

Abstract: Topical 0.1% MCFG eye drops seem to be an effective and a promising option in the treatment of refractory yeast-related corneal ulcers.

Cited by 23 publications

References 39 publications

The comparison of solitary topical micafungin or fluconazole application in the treatment of Candida fungal keratitis

The comparison of solitary topical micafungin or fluconazole application in the treatment of Candida fungal keratitis

Micafungin: A New Echinocandin

Antifúngicos em infecções oculares: drogas e vias de administração

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