antibioticsbooks

198 PART 4 Antifungal Drugs
Spectrum
Good: Candida albicans, Candida glabrata,
Candida lusitaniae, Candida parapsilosis,
Candida tropicalis, Candida krusei, Aspergillus
species
Moderate: Candida parapsilosis, some dimorphic
fungi, Zygomycetes (in combination with
amphotericin B)
Poor: most non-Aspergillus molds, Cryptococcus
neoformans
Adverse Effects
Echinocandins have an excellent safety profile.
They can cause mild histamine-mediated infusionrelated
reactions, but these are not common and
can be ameliorated by slowing the infusion rate.
Hepatotoxicity is also possible with any of these
agents, but this is not common.
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Important Facts
• Differences among the echinocandins are minor
and mostly pharmacokinetic. Caspofungin and
micafungin are eliminated hepatically by noncytochrome
P450 metabolism, while anidulafungin
degrades in the plasma and avoids
hepatic metabolism. Despite this unique method
of elimination, it is not completely devoid of
hepatotoxicity.
• Echinocandins have excellent fungicidal activity
against Candida, but against Aspergillus
species they exhibit activity that is neither
classically cidal nor static. Instead, they cause
aberrant, nonfunctional hyphae to be formed
by the actively growing mold.
• All of the echinocandins are less active against
Candida parapsilosis than the other common