Echinocandins in the management of invasive fungal infections, part 1.
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Morris MI, Villmann M
Echinocandins in the management of invasive fungal infections, part 1.
Am J Health Syst Pharm. 2006 Sep 15;63(18):1693-703.
- PubMed ID
- 16960253 [ View in PubMed]
- Abstract
PURPOSE: The chemistry, pharmacology, spectrum of activity, resistance, pharmacokinetics, pharmacodynamics, clinical efficacy, adverse effiects, drug interactions, dosage and administration, cost, and place in therapy of echinocandins are reviewed. SUMMARY: Three echinocandins are currently available: caspofungin, micafungin, and anidulafungin. The principal mechanism of action of the echinocandins is the noncompetitive inhibition of beta-(1,3)-dglucan synthase, an essential component of the cell wall of many fungi that is not present in mammalian cells. Echinocandins exhibit fungicidal activity against Candida species, including triazole-resistant isolates, and fungistatic activity against Aspergillus species. While fungistatic against mold, echinocandins may hold promise for the treatment of these pathogens when given in combination with amphotericin B or broad-spectrum triazoles, such as voriconazole. To date, resistance to echinocandins has been reported in only two patients. Echinocandins exhibit concentration- dependent activity against Candida species. In clinical trials, caspofungin has demonstrated efficacy in treating candidemia, esophageal candidiasis, and febrile neutropenia. Micafungin has demonstrated efficacy as antifungal prophylaxis in hematopoietic stem cell transplant recipients and in the treatment of esophageal candidiasis. Anidulafungin received approved labeling from the Food and Drug Administration in February 2006. Clinical efficacy data will be forthcoming. CONCLUSION: Echinocandins are fungicidal against yeast and fungistatic against mold. Their limited toxicity profile and minimal drug-drug interactions make them an attractive new option for the treatment of invasive fungal infections. Their cost may limit their use as initial therapy for patients with fungemia in medical centers or intensive care units with a high rate of triazoleresistant Candida infections.
DrugBank Data that Cites this Article
- Drugs
- Drug Targets
Drug Target Kind Organism Pharmacological Action Actions Anidulafungin 1,3-beta-glucan synthase component FKS1 Protein Aspergillus niger (strain CBS 513.88 / FGSC A1513) YesInhibitorDetails Caspofungin 1,3-beta-glucan synthase component FKS1 Protein Aspergillus niger (strain CBS 513.88 / FGSC A1513) YesInhibitorDetails Micafungin 1,3-beta-glucan synthase component FKS1 Protein Aspergillus niger (strain CBS 513.88 / FGSC A1513) YesInhibitorDetails