Cited by 214Antifungal resistance and susceptibilityFungal Plant Pathogen ControlFungal Infections and Studies

Echinocandins: The newest class of antifungals

Sucher, Allana J, Chahine, Elias B, Balcer, Holly E·2009·Annals of Pharmacotherapy

Abstract

OBJECTIVE: To review the mechanism of action, antifungal spectrum of activity, pharmacodynamics, pharmacokinetics, clinical efficacy, and safety of the echinocandins. DATA SOURCES: A MEDLINE search (1982-May 2009) was conducted for articles published in the English language using the key words caspofungin, micafungin, anidulafungin, and echinocandins. STUDY SELECTION AND DATA EXTRACTION: Medicinal chemistry, in vitro, and animal studies, as well as human trials were reviewed for information on the pharmacodynamics, pharmacokinetics, efficacy, and safety of each echinocandin. Clinical trials were reviewed and included to compare and contrast the available echinocandins. DATA SYNTHESIS: Three echinocandin antifungal agents are currently approved for use in the US: caspofungin, micafungin, and anidulafungin. The echinocandins have a unique mechanism of action, inhibiting beta-(1,3)-D-glucan synthase, an enzyme that is necessary for the synthesis of an essential component of the cell wall of several fungi. The echinocandins display fungistatic activity against Aspergillus spp. and fungicidal activity against most Candida spp., including strains that are fluconazole-resistant. The echinocandins have been shown to be efficacious for the treatment of esophageal candidiasis, candidemia, and invasive candidiasis. In addition, caspofungin has demonstrated efficacy as empiric treatment of febrile neutropenia and salvage therapy for the treatment of invasive aspergillosis, and it is the only echinocandin approved for use in pediatric patients. Micafungin is the only echinocandin approved for use as prophylaxis against Candida infections in patients undergoing hematopoietic stem cell transplantation. Overall, resistance to echinocandins is still rare, and all agents are well tolerated, with similar adverse effect profiles and few drug-drug interactions. CONCLUSIONS: Echinocandins, the newest addition to the arsenal of antifungals, offer potential advantages over other classes of agents. Clinicians should assess their distinguishing characteristics, including route of metabolism, drug interaction profile, and approved indications for use, when determining which agent to include on a formulary.

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Crossref · 10.1345/aph.1m237

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  • Echinocandins inhibit the biosynthesis of 1,3-ß-glucan by targeting two subunits of the 1,3-ß-glucan synthase encoded by FKS1 and FKS2 in Candida, eventually causing cell lysis.

    “Echinocandins inhibit the biosynthesis of an essential component of the fungal cell wall, the 1,3-ß-glucan. In Candida, they target two subunits of the 1,3-ß-glucan synthase, encoded by the FKS1 and FKS2 genes [22], and eventually cause cell lysis.”

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Authors
Sucher, A. J., Chahine, E. B., & Balcer, H. E.
Affiliations
  • Regis University (US)
  • Palm Beach Atlantic University (US)
  • Roper St. Francis Healthcare (US)
Venue
Annals of Pharmacotherapy
Published
2009-09-01
Volume
43
Issue
10
Pages
1647-1657
ISSN
  • 0012-6578 (ISSN-L)
  • 1060-0280
  • 1542-6270
OpenAlex
W2136227603
Cited by
213
References
70
Citations by year
2026: 10 · 2025: 10 · 2024: 21 · 2023: 18 · 2022: 13 · 2021: 8 · 2020: 21 · 2019: 12 · 2018: 9 · 2017: 9 · 2016: 11 · 2015: 7 · 2014: 8 · 2013: 13 · 2012: 13
FWCI
1.64
Type
journal article
Language
en
Open access
closed
Locations
  • Annals of Pharmacotherapy (publishedVersion)
  • PubMed (publishedVersion)
  • ePublications at Regis University (Regis University) (submittedVersion)
Topics
  • Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
  • Life Sciences › Agricultural and Biological Sciences › Ecology, Evolution, Behavior and Systematics › Fungal Plant Pathogen Control
  • Health Sciences › Medicine › Epidemiology › Fungal Infections and Studies
Keywords
echinocandins, caspofungin, micafungin, anidulafungin, antifungal mechanism, candidiasis, invasive aspergillosis, candidemia, esophageal candidiasis, febrile neutropenia, drug-drug interactions, antifungal resistance, pharmacokinetics, pharmacodynamics
MeSH terms
Caspofungin, Micafungin, Anidulafungin, Animals, Antifungal Agents, Aspergillosis, Candidiasis, Child, Clinical Trials as Topic, Humans, Mycoses, Drug Resistance, Fungal, Echinocandins, Lipopeptides

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