Echinocandins caspofungin

In patients who have failed initial therapy (i.e., salvage), liposomal amphotericin products, itraconazole, or the echinocandin caspofungin can be used. Itraconazole has a response rate of approximately 40%.100 Oral itraconazole exhibits erratic absorption the IV formulation is suspended in cyclodextrin, which is eliminated renally, and thus IV itraconazole should be avoided in patients with a creatinine clearance of less than 30 mL/minute (0.29 mL/s m2).103 Itraconazole also has negative inotropic cardiac effects and increases the serum concentrations of medications (e.g., cyclophosphamide, etopo-side, calcineurin inhibitors, and sirolimus). 

Echinocandin = caspofungin 70 mg loading dose, then 50 mg IV daily maintenance dose, or micafungin 100 mg daily, or anidulafungin 200 mg loading dose, then 100 mg daily maintenance dose. 

Groll, A.H. Gullick, B.M. Petraitiene, R. Petraitis, V. Csmdelario, M. Pisdtelh, S.C. Walsh, T.J. Com-partmental pharmacokinetics of the antifungal echinocandin caspofungin (MK-0991) in rabbits, Antimicrob.Agents Chemother., 2001, 45, 596-600. 

Schmatz, D. M. Liberator, P. A. Douglas, C. M. The antifungal echinocandin caspofungin acetate kills growing cells of Aspergillus fumigatus in vitro. Antimicrob. Agents Chemother. 2002, 46,... 

Echinocandins (i.e. caspofungin), semisynthetic lipo-peptides, inhibits the synthesis of (3-(l,3)-D-glucan, an... 

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... 

Caspofungin is the first of a new class termed the echinocandins. It was approved in the US and in Europe in 2001. It shows activity against infections with Aspergillus and Candida, and works by inhibiting p(, 3)-D-Glucan of the fungal cell wall. Compared to amphotericin B, caspofungin seems to have a relatively low incidence of side-effects. 

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-... 

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