infectious diseases
Antifungal Medications
Echinocandins
Echinocandins are water-soluble lipopeptides that inhibit glucan synthase. They are available only in an IV formulation. Their mechanism of action is unique among antifungals; echinocandins target the fungal cell wall, making them attractive because they lack cross-resistance with other drugs and their target is fungal and has no mammalian counterpart. Drug levels in urine and CSF are not significant. Echinocandins available in the United States areanidulafungin,caspofunginmicafungin, andrezafungin. There is little evidence to suggest that one is better than the other, butanidulafunginappears to interact with fewer medications than the others. The dose ofcaspofunginneeds to be adjusted in patients with severe hepatic insufficiency. Anidulafunginis not metabolized by the liver but is eliminated by slow, spontaneous degradation. Dose adjustment for hepatic insufficiency is not required foranidulafungin. species (see Treatment ) but are considered fungistatic against Adverse effectsof echinocandins include hepatitis and rash. 