Antifungal drugs echinocandins

J. Como, W. Dismukes (1994). Oral azole drugs as antifungal therapy. New Engl. J. Med. 330 263. D. W. Denning (2003). Echinocandin antifungal drugs. Lancet 362 1142-1151. 

The echinocandins were the first new antifungal drug class to be introduced in more than 15 years (Figure 15.2). The first echinocandin product to be marketed was caspofungin acetate (Cancidas, Merck), followed by micafungin [Funguard (Japan) and Mycamine (other countries), Fujisawa] and... 

Caspofungin, the first approved drug from a new class of antifungals, the echinocandins, has been demonstrated in three clinical trials to produce comparable clinical response to fluconazole and amphotericin B for esophageal candidiasis. The incidence of adverse events of caspo-... 

Current W, Turner W. Echinocandins—cyclic peptide antifungal drugs for the future. Strohl W, ed. Biotechnology of Industrial Antibiotics, 2nd ed. New York Marcel Dekker, 1996. 

Select azole antifungals (e.g., itraconazole, voriconazole, and posaconazole) and the echinocandins are available for IA treatment. For initial therapy of IA, voriconazole had higher response and survival rates than c-AMB.102 An advantage of voriconazole is its 96% oral bioavailability, making use of this oral drug an attractive and less expensive alternative. The dose of voriconazole was 6 mg/kg IV every 12 hours for two doses, followed by 4 mg/kg IV every 12 hours for at least 7 days, at which time oral voriconazole 200 mg every 12 hours could be administered. Common toxicities reported with voriconazole include infusion-related, transient visual disturbances (i.e., blurred vision, altered color perception, photophobia, and visual hallucinations), skin reactions (i.e., rash, pruritus, and photosensitivity), elevations in hepatic transaminases and alkaline phosphatase, nausea, and headache.102 In addition, voriconazole increases the serum concentrations of medications cleared by cytochrome P-450 2C9, 2C19, and 3A4 (e.g., cyclophosphamide and calcineurin inhibitors) concomitant voriconazole-sirolimus should be avoided.103... 

Wiederhold NP, Lewis RE The echinocandin antifungals An overview of the pharmacology, spectrum and clinical efficacy. Expert Opin Investig Drugs 2003 12 1313. [PMID 12882619]... 

Resistance to other antifungal agents such as amphotericin B has been observed less frequently in clinical fungal isolates however, the molecular basis of this resistance is not currently well understood. To solve the problems associated with antifungal resistance a number of novel azole drugs (e.g. voriconazole) and novel classes of drug (e.g echinocandins) have been developed (see Chapter 12). 

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