Echinocandins antifungals

Joseph JM, Jain R, Danziger LH. (2007) Micafungin Anew echinocandin antifungal. Pharmacotherapy 27 53-67. 

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. 

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]... 

WW Turner, WL Current. Echinocandin antifungal agents. In WR Strohl, ed. Biotechnology of Antibiotics. New York Marcel Dekker, 1997, pp 315-334. 

Caspofungin is an echinocandins/antifungal agent that inhibits synthesis of p-(l,3)-D-glucan, an integral component of fungal cell wall. 

Raasch RH. Anidulafungin review of a new echinocandin antifungal agent. Expert Rev Anti-Infect Ther 2004 2 499-508. 

Dowell J, Knebel W, Ludden T, Stx piew M, Krause D, Henkel T. Peculation phannacokinet ic analysis of anidulafin in, an echinocandin antifungal J Clin Pharmacol (2004) 44 590-8. 

Echinocandin Antifungal Agents WUliam W Turner And WUliam L. Current... 

Tamura K, Urabe A, Yoshida M, Kanamaru A, Kodera Y, Okamoto S, Maesaki S, Masaoka T. Efficacy and safety of micafungin, an echinocandin antifungal agent, on invasive fungal infections in patients with hematological disorders. Leuk Lymphoma 2009 50 92-100. 

Response to antifungal therapy in invasive candidiasis is often more rapid than for endemic fungal infections. Resolution of fever and sterilization of blood cultures are indications of response to antifungal therapy. Toxicity associated with antifungal therapy is similar in these patients as described earlier with the caveat that some toxicities maybe more pronounced in crit-ically-ill patients with invasive candidiasis. Nephrotoxicity and electrolyte disturbances, with amphotericin B in particular, are problematic and may not be avoidable even with lipid amphotericin B formulations. Fluconazole and echinocandins are generally safer options, and are generally well tolerated. Decisions to use one class of agents over the other is principally driven by concerns of non-albicans species, patient tolerability, or history of prior fluconazole exposure (risk factor for non-albicans species.). 

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... 

The echinocandins have a unique target for their antifungal activity—specifically, (5-1,3-glucan synthase, an enzyme that produces an important component of the fungal wall. Caspofungin is currently the only product of this class that is FDA approved it is indicated for treatment of IA refractory... 

FR901379 - echinocandin-like lipopeptide with antifungal property... 

Anidulafimgin (23 Echinocandin B (24) Lipopeptide Semi-synthetic Microbial Antifungal Inhibits fungal cell wall 279-293... 

Deoxymulundo-candin (158) Echinocandin- type antifungal antibiotic Aminocandin (NXL-201, IP960, HMR-3270)(159) Antifungal (Candida sp. infections) Targets the glucan in fungal cell walls Phase I Novexel 825-827... 

Denning DW. (1997) Echinocandins and pneumocandins — a new antifungal class with a novel mode of action. J Antimicrob Chemother 40 611-614. 

Mukhopadhyay T, Roy K, Bhat RQ Sawant SN, Blumbach J, Ganguli BN, Fehlhaber HW, Kogler H. (1992) Deoxymulundocandin — a new echinocandin type antifungal antibiotic. J Antibiot 45 618-623. 

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