title: The echinocandins: comparison of their pharmacokinetics, pharmacodynamics and clinical applications.
abstract: Caspofungin, micafungin and anidulafungin are three drugs of the echinocandin class of antifungals available for intravenous treatment of invasive candidiasis and aspergillosis. They exhibit high in vitro and in vivo activities against Candida spp. and Aspergillus spp. In various clinical studies investigating candidemia and invasive candidiasis, Candida esophagitis, and fever in neutropenia, the clinical efficacy of the echinocandin tested was similar to that of established antifungals. Antifungal activity against strains no longer susceptible to conventional antifungal agents, such as fluconazole and amphotericin B suggests that echinocandins can be used as salvage therapy in life-threatening fungal infections. There is no cross-resistance to other antifungals. Excellent safety and tolerability of treatment with caspofungin has been documented over a total of 4.3 million patient days. Echinocandins are poor substrates of the cytochrome P450 enzyme family and can be safely co-administered with most drugs without the need for dosage adaptation. No dose reduction is required in renal impairment. A reduction in the daily maintenance dose has been recommended for caspofungin, but not for micafungin and anidulafungin in patients presenting with mild to moderate hepatic failure.
authors.affiliation: Department of Clinical Pharmacology, Division of Clinical Pharmacokinetics, Medical University of Vienna, Vienna, Austria.
authors.forename: Claudia
authors.initials: C
authors.lastname: Wagner
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Graninger
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Presterl
authors.forename: Christian
authors.initials: C
authors.lastname: Joukhadar
mesh_terms: D000199:Actins / Q000737:chemistry; D000666:Amphotericin B / Q000494:pharmacology; D000077612:Anidulafungin; D000818:Animals; D000935:Antifungal Agents / Q000493:pharmacokinetics* / Q000494:pharmacology*; D019540:Area Under Curve; D002177:Candidiasis / Q000188:drug therapy* / Q000517:prevention & control; D000077336:Caspofungin; D004352:Drug Resistance, Microbial; D054714:Echinocandins; D006801:Humans; D055666:Lipopeptides; D008074:Lipoproteins / Q000493:pharmacokinetics*; D008099:Liver / Q000382:microbiology; D017093:Liver Failure / Q000517:prevention & control; D000077551:Micafungin; D008956:Models, Chemical; D010456:Peptides, Cyclic / Q000493:pharmacokinetics*; D051381:Rats
chemical_list: D000199:Actins; D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D008074:Lipoproteins; D010456:Peptides, Cyclic; D000666:Amphotericin B; D000077612:Anidulafungin; D000077336:Caspofungin; D000077551:Micafungin