The role of caspofungin and the echinocandins in the antifungal armamentarium.
The echinocandins are a recently-developed class of antifungal agents that interfere with fungal cell wall synthesis through the inhibition of glucan synthesis. Although several intravenous preparations are in various stages of development, caspofungin is the only currently approved agent and no oral echinocandin derivatives are presently available. Caspofungin is approved for the treatment of invasive aspergillosis in patients who are refractory to, or intolerant of, other antifungal therapies. This agent has activity against most Candida species, and in a prospective randomized trial, was as effective as, and better tolerated than amphotericin B in the treatment of candidal esophagitis. Activity against the cyst form of Pneumocystis carinii has also been demonstrated. Caspofungin is administered in a daily intravenous dose, and is well tolerated. Concomitant use of this agent with cyclosporine is presently not recommended. Other echinocandin derivatives presently in phase II/III clinical development include micafungin and anidulafungin.
Morrison
Vicki A
VA
Section of Hematology/Oncology, Veterans Affirs Medical Center, Minneapolis, MN 55417 USA. morri002@tc.umn.edu
D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000494:pharmacology / Q000627:therapeutic use*; D000077336:Caspofungin; D002986:Clinical Trials as Topic; D004334:Drug Administration Schedule; D004347:Drug Interactions; D025141:Drug Resistance, Fungal; D054714:Echinocandins; D005656:Fungal Proteins; D006801:Humans; D055666:Lipopeptides; D010455:Peptides; D010456:Peptides, Cyclic
D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D054714:Echinocandins; D005656:Fungal Proteins; D055666:Lipopeptides; D010455:Peptides; D010456:Peptides, Cyclic; C007572:echinocandin B; D000077336:Caspofungin