Charitè University Medicine, Department of Medicine, Division of Oncology/ Hematology, Charitè Campus Mitte, Berlin, Germany.
Eur J Med Res. 2011 Apr 28;16(4):159-66. doi: 10.1186/2047-783x-16-4-159.
Echinocandins represent the newest class of antifungal agents. Currently, three echinocandins, anidulafungin, caspofungin and micafungin are licensed for clinical use in various indications. They act as inhibitors of β-(1,3)-glucan synthesis in the fungal cell wall and have a favorable pharmacological profile. They have a broad spectrum of activity against all Candida species. Higher MIC's have been observed against C. parapsilosis and C. guilliermondii. Data from clinical trials for invasive Candida infections / candidaemia suggest that the clinical outcome of patients treated with either drug may be very similar. A comparison has been done between caspofungin and micafungin but for anidulafungin a comparative trial with another echinocandin is still lacking. All three drugs are highly effective if not superior to treatment with either fluconazole or Amphotericin B, particularly in well-defined clinical settings such as invasive Candida infections, Candida oesophagitis and candidaemia. Differences between the three echinocandins with regard to the route of metabolism, requirement for a loading dose, dose adjustment in patients with moderate to severe hepatic disease and different dosing schedules for different types of Candida infections have to be considered. Relevant drug-drug interactions of Caspofungin and Micafungin are minimal. Anidulafungin has no significant drug interactions at all. However, echinocandins are available only for intravenous use. All three agents have an excellent safety profile.
棘白菌素类是最新的一类抗真菌药物。目前，三种棘白菌素，即安尼卡宾、卡泊芬净和米卡芬净，已获准在各种适应证中临床应用。它们作为真菌细胞壁β-(1,3)-葡聚糖合成的抑制剂，具有良好的药理学特性。它们对所有念珠菌属物种均具有广谱活性。对近平滑念珠菌和季也蒙念珠菌的 MIC 值较高。侵袭性念珠菌感染/念珠菌血症的临床试验数据表明，接受这两种药物治疗的患者的临床结局可能非常相似。已对卡泊芬净和米卡芬净进行了比较，但对于安尼卡宾，仍缺乏与另一种棘白菌素的对照试验。如果不是优于氟康唑或两性霉素 B 的治疗，这三种药物都非常有效，尤其是在明确的临床环境中，如侵袭性念珠菌感染、念珠菌食管炎和念珠菌血症。在代谢途径、负荷剂量要求、中重度肝疾病患者的剂量调整以及不同类型念珠菌感染的不同剂量方案方面，三种棘白菌素之间存在差异。卡泊芬净和米卡芬净的相关药物相互作用最小。安尼卡宾则完全没有显著的药物相互作用。然而，棘白菌素类仅可静脉使用。所有三种药物均具有极佳的安全性。
