The
echinocandins are a new class of antifungals, developed in response to the need for safe and effective antifungals for the treatment of
invasive fungal infections. These agents work by inhibiting 1,3-beta-d-glucan synthase, an
enzyme essential for production of cell walls in select fungi.
Echinocandins appear to demonstrate favourable activity in vitro against a variety of yeasts (including both Candida albicans and non-albicans Candida) as well as select moulds (including Aspergillus spp.) In general, all echninocandins demonstrate a favourable safety profile and require once-daily parenteral administration.
Caspofungin is the first of these agents to be available in the US, and is approved for empirical antifungal
therapy in febrile neutropenic patients, candidaemia and select forms of
invasive candidiasis, and for management of invasive
aspergillosis in patients refractory to or intolerant of other
therapies.
Micafungin was recently approved by the FDA for treatment of oesophageal
candidiasis, and for the prophylaxis of
fungal infections in haematopoietic stem cell transplant recipients. Emerging data indicate
micafungin may have an important role in the treatment of invasive forms of
candidiasis.
Anidulafungin is an
echinocandin approved in the US for treatment of candidaemia and oesophageal
candidiasis.
Aminocandin (HMR-3702, IP-960) is an investigational agent, with published experience limited to in vitro studies and animal models of
infection.