ABSTRACT
INTRODUCTION Echinocandins are the most recent addition to the antifungal armamentarium, with a unique mechanism of action. There are currently three echinocandin antifungal agents in clinical use: caspofungin, micafungin, and anidulafungin. These agents block fungal cell wall synthesis through inhibition of -(1,3)-D-glucan synthase, resulting in fungicidal effects against Candida spp. and fungistatic effects against Aspergillus spp. Echinocandins have also been shown to have some activity, alone or in combination with other agents against a variety of other fungal pathogens. Several clinical trials have evaluated performance of echinocandins in the setting of oropharyngeal/esophageal candidiasis, and invasive candidiasis. Others have reported experience with echinocandins as salvage therapy for invasive aspergillosis, and case reports describe efficacy of these agents in the treatment of a variety of other fungal infections. In general, echinocandins have become preferred agents in the hospital setting for invasive candidiasis because of broad activity against non-albicans Candida as well as Candida albicans infections while having an excellent safety profile and relative lack of drug interactions. Since they are available only in intravenous form, their use is limited in patients where oral antifungal therapy is preferable.
