Echinocandins

The class comprises semisynthetic cyclic lipopeptides used especially for invasive Candida infections. Caspofungin (Cancidas) was approved in 2001, micafungin (Mycamine) in 2005 and anidulafungin (Eraxis) in 2006. Rezafungin (Rezzayo), approved in 2023, is a newer once-weekly member. All are administered intravenously; this is a group-level reference rather than one interchangeable drug.

Echinocandins inhibit 1,3-beta-D-glucan synthase, preventing construction of the glucan polymer that strengthens fungal cell walls. Weakened cells cannot withstand internal pressure. Activity is fungicidal for most Candida species and fungistatic against Aspergillus.

Human cells lack both a cell wall and the equivalent enzyme, contributing to relative target selectivity. Caspofungin, micafungin and anidulafungin are normally infused daily; rezafungin is weekly. Caspofungin was at least as effective as amphotericin B for invasive candidiasis with fewer adverse effects, while anidulafungin exceeded fluconazole on its pivotal trial’s primary endpoint.

None of these products carries a boxed warning in the described labeling.

These agents treat invasive Candida disease, including bloodstream infection, and esophageal candidiasis. Additional member-specific uses include caspofungin for suspected fungal disease in neutropenic fever and selected Aspergillus infections, and micafungin for Candida prevention in stem-cell transplant recipients.

Common adverse effects include fever, infusion flushing/rash/itching, nausea, headache, low potassium and elevated liver enzymes. More significant hepatic dysfunction and severe allergy occur rarely. Caspofungin requires attention to hepatic impairment and certain drug interactions; dosing rules should not be transferred indiscriminately between members.