Echinocandins: Antifungal Medications

Echinocandins

Overview

• A class of antifungal medications that inhibit the synthesis of beta-1,3-glucan, a key component of the fungal cell wall
• Used to treat invasive aspergillosis, candidemia, and other fungal infections

Mechanism of Action

• Inhibit the enzyme glucan synthase, which is necessary for the synthesis of beta-1,3-glucan
• Disrupt the integrity of the fungal cell wall, leading to cell death

Examples of Echinocandins

• Caspofungin
• Micafungin
• Anidulafungin
• Rezafungin (experimental)

Pharmacokinetics

• Administered intravenously
• Distributed widely throughout the body, including the CNS
• Undergo hepatic metabolism, with minimal renal excretion

Adverse Effects

• Common: infusion reactions, nausea, vomiting, diarrhea, headache
• Less common: elevations in liver enzymes, hypokalemia, rash
• Rare: anaphylaxis, Stevens-Johnson syndrome

Drug Interactions

• May interact with cyclosporine, tacrolimus, and sirolimus, increasing the risk of liver toxicity
• May interact with warfarin, increasing the risk of bleeding

Resistance

• Fungal resistance to echinocandins is rare, but emerging
• Mechanisms of resistance include mutations in the FKS1 gene, which encodes the glucan synthase subunit

Indications

• Invasive aspergillosis
• Candidemia
• Invasive candidiasis
• Esophageal candidiasis
• Empirical therapy for febrile neutropenia

Echinocandins

• A class of antifungal medications that inhibit the synthesis of beta-1,3-glucan, a key component of the fungal cell wall
• Used to treat invasive aspergillosis, candidemia, and other fungal infections

Mechanism of Action

• Inhibit the enzyme glucan synthase, necessary for the synthesis of beta-1,3-glucan
• Disrupt the integrity of the fungal cell wall, leading to cell death

Examples

• Caspofungin
• Micafungin
• Anidulafungin
• Rezafungin (experimental)

Pharmacokinetics

• Administered intravenously
• Distributed widely throughout the body, including the CNS
• Undergo hepatic metabolism, with minimal renal excretion

Adverse Effects

• Infusion reactions
• Nausea, vomiting, diarrhea, headache
• Elevations in liver enzymes
• Hypokalemia
• Rash
• Anaphylaxis
• Stevens-Johnson syndrome (rare)

Drug Interactions

• Increase risk of liver toxicity with cyclosporine, tacrolimus, and sirolimus
• Increase risk of bleeding with warfarin

Resistance

• Fungal resistance to echinocandins is rare, but emerging
• Mechanisms of resistance include mutations in the FKS1 gene, which encodes the glucan synthase subunit

Indications

• Invasive aspergillosis
• Candidemia
• Invasive candidiasis
• Esophageal candidiasis
• Empirical therapy for febrile neutropenia

Learn about Echinocandins, a class of antifungal medications that inhibit the synthesis of beta-1,3-glucan, used to treat invasive aspergillosis and candidemia.