Echinocandins; (e) echinocandins

Echinocandins are semi-synthetic antimicrobials for intravenous use only. Chemically, they are lipophilically substituted cyclic polypeptides (lipopeptides) obtained from fungal cultures. Echinocandins are only slowly metabolically eliminated.

Important representatives of this group of substances are:

• caspofungin
• Anidulafungin
• Micafungin

Echinocandins specifically inhibit the synthesis of 1,3-β-D-glucan. The inhibition of the enzyme glucan synthase leads to an inhibition of the glucan fibrils which, together with chitin, form the basic structure of the cell wall of fungi. The lack of glucan fibrils leads to a dysbalance of the cell wall.

Echocandins have a fungicidal effect on shoot fungi, but only a fungistatic effect on askomyotic moulds. Due to the selective mechanism of action, the broad spectrum of action on shoots and moulds and the good compatibility of the substances is justified. Resistances are rare. It is important that Echinocandine is effective against the fungus Pneumocystis jiroveci (Pneumocystis carinii).

Severe esophageal candidiasis, invasive candidiasis with candiemia.

Since basidiomycetes and mucoraceae have only little glucan in the cell wall, they are per se resistant to echinocandins.

In comparison with amphotericin B and triazole antifungals, echinocandins are well tolerated. Possible side effects are infusion-associated disorders resulting from histamine release and in the worst case leading to anaphylactoid reactions.

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