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chapter 30 Echinocandins 199
clinical species. It has yet to be determined
whether this is likely to result in clinical failure,
because this organism has been successfully
treated with these drugs. If your patient is
infected with this organism, be sure to change
any IV catheters your patient has and consider
fluconazole therapy instead.
• Though drug interactions with the echinocandins
are minor, you should be aware of some
of them, particularly with caspofungin and
micafungin. Be careful when you use them
with the immunosuppressants cyclosporine
(caspofungin) and sirolimus (micafungin).
What They’re Good For
Echinocandins are drugs of choice for invasive
candidiasis, particularly in patients who are clinically
unstable. They are also useful in the treatment
of invasive aspergillosis but do not have the
level of supporting data that voriconazole and
the polyenes do for this indication. All of them
are used for esophageal candidiasis, and some
are used in prophylaxis or empiric therapy of
fungal infections in neutropenic patients. Recent
evidence has shown that caspofungin added to
an amphotericin B formulation may result in
improved outcomes in Zygomycete infections.
Don’t Forget!
Echinocandins are great drugs for invasive candidiasis,
but they are not cheap. After beginning
empiric therapy with an echinocandin, transition
your patient to fluconazole if he or she has a susceptible
strain of Candida and no contraindication
to fluconazole.