Abstract
Purpose. The chemistry, pharmacology, spectrum of activity, resistance, pharmacokinetics, pharmacodynamics, clinical efficacy, adverse effects, 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 β-(1,3)-D-glucan 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 triazole-resistant Candida infections.
| Original language | English |
|---|---|
| Pages (from-to) | 1813-1820 |
| Number of pages | 8 |
| Journal | American Journal of Health-System Pharmacy |
| Volume | 63 |
| Issue number | 19 |
| DOIs | |
| State | Published - Oct 1 2006 |
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Keywords
- Anidulafungin
- Antifungals
- Caspofungin
- Combined therapy
- Concentration
- Costs
- Dosage
- Drug administration
- Drug interactions
- Mechanism of action
- Micafungin
- Mycoses
- Pharmacodynamics
- Pharmacokinetics
- Resistance
- Spectrum microbial
- Toxicity medicine
ASJC Scopus subject areas
- Pharmaceutical Science
- Leadership and Management
Cite this
Echinocandins in the management of invasive fungal infections, part 2. / Morris, Michele I; Villmann, Mark.
In: American Journal of Health-System Pharmacy, Vol. 63, No. 19, 01.10.2006, p. 1813-1820.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Echinocandins in the management of invasive fungal infections, part 2
AU - Morris, Michele I
AU - Villmann, Mark
PY - 2006/10/1
Y1 - 2006/10/1
N2 - Purpose. The chemistry, pharmacology, spectrum of activity, resistance, pharmacokinetics, pharmacodynamics, clinical efficacy, adverse effects, 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 β-(1,3)-D-glucan 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 triazole-resistant Candida infections.
AB - Purpose. The chemistry, pharmacology, spectrum of activity, resistance, pharmacokinetics, pharmacodynamics, clinical efficacy, adverse effects, 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 β-(1,3)-D-glucan 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 triazole-resistant Candida infections.
KW - Anidulafungin
KW - Antifungals
KW - Caspofungin
KW - Combined therapy
KW - Concentration
KW - Costs
KW - Dosage
KW - Drug administration
KW - Drug interactions
KW - Mechanism of action
KW - Micafungin
KW - Mycoses
KW - Pharmacodynamics
KW - Pharmacokinetics
KW - Resistance
KW - Spectrum microbial
KW - Toxicity medicine
UR - http://www.scopus.com/inward/record.url?scp=33749175208&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=33749175208&partnerID=8YFLogxK
U2 - 10.2146/ajhp050464.p2
DO - 10.2146/ajhp050464.p2
M3 - Article
C2 - 16990627
AN - SCOPUS:33749175208
VL - 63
SP - 1813
EP - 1820
JO - American Journal of Health-System Pharmacy
JF - American Journal of Health-System Pharmacy
SN - 1079-2082
IS - 19
ER -