JAC Advance Access published online on January 28, 2003
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkg117
© 2003 by The British Society for Antimicrobial Chemotherapy
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Review
1 Institut de Parasitologie
et de Pathologie Tropicale, Faculté de Médecine,
3 rue Koeberlé, 67000 Strasbourg
* Corresponding author. E-mail: raoul.herbrecht{at}chru-strasbourg.fr.
Caspofungin (MK-0991; L-743,872) belongs to the echinocandin
family, a new class of antifungal agents that act on the fungal
cell wall by inhibiting glucan synthesis. Data in vitro,
and experimental studies, have demonstrated that caspofungin has
antifungal activity against yeasts of the genus Candida (including
isolates resistant to azoles and amphotericin B), several species of
filamentous fungi, including Aspergillus, and certain
dimorphic fungi, such as Histoplasma, Blastomyces and Coccidioides. In vitro and in
animals, caspofungin shows additive or synergic antifungal activity
with amphotericin B and triazoles. It also possesses activity against Pneumocystis carinii. Clinical trials have shown
caspofungin to be well tolerated and effective in invasive aspergillosis
in patients refractory or intolerant to standard treatment (45% favourable responses),
in oropharyngeal and oesophageal candidiasis (67-93% favourable
responses with an efficacy similar to those of amphotericin B and
fluconazole), and in invasive candidiasis with efficacy equivalent
to that of amphotericin B, and better tolerability. The results
of these first clinical trials were promising, and led to the approval
of caspofungin for invasive aspergillosis after failure of, or intolerance
to, standard therapy. Further studies are required to define the exact
role of caspofungin in the antifungal armamentarium.
Keywords: echinocandin, candidaemia, oropharyngeal candidiasis,
oesophageal candidiasis, invasive
aspergillosis
Caspofungin: the first representative of a new
antifungal class
2 Département d'Hématologie
et d'Oncologie, Hôpital de Hautepierre, 67098
Strasbourg, France
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