Pharmacology and metabolism of anidulafungin, caspofungin and micafungin in the treatment of invasive candidosis: review of the literature.
Pharmacology and metabolism of anidulafungin, caspofungin and micafungin in the treatment of invasive candidosis: review of the literature.
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DOI：
10.1186/2047-783x-16-4-159
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发表时间：
2011-04-28
影响因子：
4.2
通讯作者：
Ruhnke M
中科院分区：
文献类型：
--
作者：
Kofla G;Ruhnke M
棘白菌素是一类最新的抗真菌药物。目前，三种echinocandins， anidulafungin， caspofungin和micafungin已获准用于各种适应症的临床应用。它们作为真菌细胞壁β-(1,3)-葡聚糖合成的抑制剂，具有良好的药理作用。它们对所有念珠菌种类都有广泛的活性。观察到较高的MIC值对假梭菌和吉列蒙地梭菌。侵袭性念珠菌感染/念珠菌血症的临床试验数据表明，使用这两种药物治疗的患者的临床结果可能非常相似。caspofungin和micafungin之间已经进行了比较，但是anidulafungin与另一种棘白菌素的比较试验仍然缺乏。这三种药物即使不优于氟康唑或两性霉素B，也非常有效，特别是在明确的临床环境中，如侵袭性念珠菌感染、念珠菌食管炎和念珠菌血症。必须考虑三种棘白菌素在代谢途径、负荷剂量要求、中重度肝病患者的剂量调整以及不同类型念珠菌感染的不同给药方案等方面的差异。Caspofungin和Micafungin的相关药物-药物相互作用最小。Anidulafungin完全没有明显的药物相互作用。然而，棘白菌素仅可用于静脉注射。这三种药剂的安全性都很好。
Echinocandins represent the newest class of antifungal agents. Currently, three echinocandins, anidulafungin, caspofungin and micafungin are licensed for clinical use in various indications. They act as inhibitors of β-(1,3)-glucan synthesis in the fungal cell wall and have a favorable pharmacological profile. They have a broad spectrum of activity against all Candida species. Higher MIC's have been observed against C. parapsilosis and C. guilliermondii. Data from clinical trials for invasive Candida infections/candidaemia suggest that the clinical outcome of patients treated with either drug may be very similar. A comparison has been done between caspofungin and micafungin but for anidulafungin a comparative trial with another echinocandin is still lacking. All three drugs are highly effective if not superior to treatment with either fluconazole or Amphotericin B, particularly in well-defined clinical settings such as invasive Candida infections, Candida oesophagitis and candidaemia. Differences between the three echinocandins with regard to the route of metabolism, requirement for a loading dose, dose adjustment in patients with moderate to severe hepatic disease and different dosing schedules for different types of Candida infections have to be considered. Relevant drug-drug interactions of Caspofungin and Micafungin are minimal. Anidulafungin has no significant drug interactions at all. However, echinocandins are available only for intravenous use. All three agents have an excellent safety profile.
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