Comparison of echinocandin antifungals.
Comparison of echinocandin antifungals.
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DOI：
10.2147/tcrm.2007.3.1.71
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发表时间：
2007-03-01
影响因子：
2.8
通讯作者：
Carver, Peggy L
中科院分区：
文献类型：
--
作者：
Eschenauer, Gregory;Depestel, Daryl D;Carver, Peggy L
侵袭性真菌感染的发生率，尤其是由曲霉属引起的感染。和念珠菌属，继续增加。尽管医疗实践取得了进步，但这些感染造成的相关死亡率仍然很高。棘白菌素抗真菌药为临床医生提供了治疗严重真菌感染的另一种选择。这些药物具有全新的作用机制，耐受性相对良好，并且发生严重药物相互作用的可能性较低。目前，棘白菌素是治疗念珠菌属感染（例如食管念珠菌病、侵袭性念珠菌病和念珠菌血症）的一种选择。此外，卡泊芬净是治疗难治性曲霉病的可行选择。尽管米卡芬净尚未获得食品和药物管理局批准用于该适应症，但最近的数据表明它也可能有效。最后，对于曲霉属引起的严重感染的治疗应考虑含卡泊芬净或米卡芬净的联合疗法。尽管棘白菌素有许多共同的特性，但有关它们之间差异的数据正在迅速出现。阿尼芬净表现出独特的药代动力学特征，并且少数病例显示出在卡泊芬净和米卡芬净最低抑制浓度增加的分离株中具有潜在的活性。卡泊芬净的副作用发生率和药物间相互作用的可能性略高。再加上一些念珠菌菌株敏感性降低的证据，可能会降低其未来的效用。然而，与其他药物相比，我们必须在更多的数据和使用卡泊芬净的背景下看待这些发现。米卡芬净似乎与卡泊芬净非常相似，两种药物之间几乎没有明显差异。
The incidence of invasive fungal infections, especially those due to Aspergillus spp. and Candida spp., continues to increase. Despite advances in medical practice, the associated mortality from these infections continues to be substantial. The echinocandin antifungals provide clinicians with another treatment option for serious fungal infections. These agents possess a completely novel mechanism of action, are relatively well-tolerated, and have a low potential for serious drug-drug interactions. At the present time, the echinocandins are an option for the treatment of infections due Candida spp (such as esophageal candidiasis, invasive candidiasis, and candidemia). In addition, caspofungin is a viable option for the treatment of refractory aspergillosis. Although micafungin is not Food and Drug Administration-approved for this indication, recent data suggests that it may also be effective. Finally, caspofungin- or micafungin-containing combination therapy should be a consideration for the treatment of severe infections due to Aspergillus spp. Although the echinocandins share many common properties, data regarding their differences are emerging at a rapid pace. Anidulafungin exhibits a unique pharmacokinetic profile, and limited cases have shown a potential far activity in isolates with increased minimum inhibitory concentrations to caspofungin and micafungin. Caspofungin appears to have a slightly higher incidence of side effects and potential for drug-drug interactions. This, combined with some evidence of decreasing susceptibility among some strains of Candida, may lessen its future utility. However, one must take these findings in the context of substantially more data and use with caspofungin compared with the other agents. Micafungin appears to be very similar to caspofungin, with very few obvious differences between the two agents.