equinocandinas

Echinocandins, or equinocandinas in some languages, are a class of antifungal drugs that inhibit the enzyme 1,3-beta-D-glucan synthase, blocking synthesis of an essential fungal cell wall component. This leads to weakening of the cell wall and fungal death in susceptible organisms. They are generally fungicidal against Candida species and are typically fungistatic against many molds, including Aspergillus species.

The primary clinical use is for invasive candidiasis, including candidemia and deep-seated candidiasis, as well as esophageal candidiasis. They are also employed as salvage therapy for invasive aspergillosis in patients who fail or cannot tolerate other antifungals. Echinocandins have limited activity against Cryptococcus species and most Mucorales, and are not active against all fungi.

Pharmacokinetics and administration: all approved echinocandins are administered intravenously and have limited oral bioavailability. They are generally administered once daily, with drug exposure influenced by hepatic metabolism to inactive metabolites and fecal excretion; renal adjustment is usually not required. The need for dose adjustments varies by specific agent in the setting of hepatic impairment, and clinical guidelines provide agent-specific recommendations.

Safety, resistance, and limitations: echinocandins are generally well tolerated. Common adverse effects include infusion-site reactions, fever, rash, and nausea; mild elevations in liver enzymes can occur, particularly with hepatic impairment. They carry a low risk of nephrotoxicity and have fewer drug interactions. Resistance can arise through mutations in the FKS1 or FKS2 genes, leading to reduced susceptibility, notably in Candida glabrata and some Candida parapsilosis isolates.

Overall, echinocandins are a cornerstone therapy for invasive candidiasis and a valuable option in refractory mold infections, with favourable safety and interaction profiles and distinct limitations in spectrum and CNS penetration.