{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T12:37:07Z","timestamp":1789994227885,"version":"4.0.1"},"reference-count":118,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2012,1,6]],"date-time":"2012-01-06T00:00:00Z","timestamp":1325808000000},"content-version":"vor","delay-in-days":1772,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2007,3]]},"abstract":"<jats:p>The changing pattern in fungal infections has driven the need to expand the targets of antifungal activity. The echinocandins are the newest addition to the arsenal against fungal infections. Three echinocandins have been approved by the United States Food and Drug Administration: caspofungin, micafungin, and anidulafungin. These agents have a broad spectrum of activity and are similar to each other with respect to in vitro activity against <jats:italic>Candida<\/jats:italic> sp, with micafungin and anidulafungin having similar minimum inhibitory concentrations (MICs) that are generally lower than the MIC of capsofungin. The MICs of the echinocandins are highest against <jats:italic>Candida parapsilosis<\/jats:italic>; however, whether this will affect clinical outcomes is unknown. Several case reports have identified clinical failure due to elevated MICs with caspofungin or micafungin against <jats:italic>Candida albicans, Candida krusei<\/jats:italic>, and <jats:italic>C. parapsilosis<\/jats:italic>. Resistance to the echinocandin class was present in some but not all of the isolates. Empiric therapy with one of the echinocandins for candidemia or invasive candidiasis in patients with neutropenia and those without neutropenia appears to be appropriate when one factors in mortality rate, the increasing frequency of <jats:italic>non\u2010albicans Candida<\/jats:italic> infections, and the broad spectrum, safety, and fungicidal effect of the echinocandins. After speciation of the organism, continued therapy with an echinocandin can and should be reevaluated. The echinocandins demonstrate similar in vitro and in vivo activity against <jats:italic>Aspergillus<\/jats:italic> sp, but only caspofungin is approved for treatment in patients who are intolerant of or refractory to other therapies. Voriconazole and amphotericin B have demonstrated synergy with the echinocandins. The clinical response to combination therapy has been variable; however, the mortality rate appears to be lower with combination therapy than monotherapy. Large controlled trials are needed to determine the role of combination therapy for invasive aspergillosis. Micafungin and anidulafungin generally have a lower frequency of adverse reactions compared with caspofungin. Phlebitis (3.5\u201325% of patients) and elevated liver enzyme levels (1\u201315%) occur more often with caspofungin compared with micafungin and anidulafungin (&lt; 8%). Overall, the three echinocandins are relatively safe and effective agents for the treatment of <jats:italic>Candida<\/jats:italic> infections.<\/jats:p>","DOI":"10.1592\/phco.27.3.369","type":"journal-article","created":{"date-parts":[[2007,2,23]],"date-time":"2007-02-23T11:21:56Z","timestamp":1172229716000},"page":"369-388","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":202,"title":["The Echinocandins"],"prefix":"10.1002","volume":"27","author":[{"given":"Diane","family":"Cappelletty","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kasi","family":"Eiselstein\u2010McKitrick","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2012,1,6]]},"reference":[{"key":"e_1_2_1_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dki218"},{"key":"e_1_2_1_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000202435.98240.ED"},{"key":"e_1_2_1_4_2","doi-asserted-by":"publisher","DOI":"10.1086\/520192"},{"key":"e_1_2_1_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.inf.0000078159.53132.40"},{"key":"e_1_2_1_6_2","doi-asserted-by":"publisher","DOI":"10.1086\/374339"},{"key":"e_1_2_1_7_2","doi-asserted-by":"publisher","DOI":"10.1086\/421946"},{"key":"e_1_2_1_8_2","doi-asserted-by":"publisher","DOI":"10.1513\/pats.200510-110JH"},{"key":"e_1_2_1_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2003.08.012"},{"key":"e_1_2_1_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/00001432-200212000-00003"},{"key":"e_1_2_1_11_2","volume-title":"Cancidas (caspofungin) package insert","author":"Merck & Co.","year":"2001"},{"key":"e_1_2_1_12_2","volume-title":"Mycamine (micafungin) package insert","author":"Pharma Astellas US","year":"2005"},{"key":"e_1_2_1_13_2","volume-title":"Eraxis (anidulafungin) package insert","author":"Pfizer Inc.","year":"2006"},{"key":"e_1_2_1_14_2","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.6.1.1"},{"key":"e_1_2_1_15_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.41.11.2326"},{"key":"e_1_2_1_16_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-0691.2004.00996.x"},{"key":"e_1_2_1_17_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.47.7.2100-2107.2003"},{"key":"e_1_2_1_18_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.46.9.3001-3012.2002"},{"key":"e_1_2_1_19_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.45.10.2845-2855.2001"},{"key":"e_1_2_1_20_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.46.1.12-23.2002"},{"key":"e_1_2_1_21_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.46.6.1857-1869.2002"},{"key":"e_1_2_1_22_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10096-004-1171-z"},{"key":"e_1_2_1_23_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.48.7.2730-2732.2004"},{"key":"e_1_2_1_24_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.46.12.3846-3853.2002"},{"key":"e_1_2_1_25_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/42.3.289"},{"key":"e_1_2_1_26_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.49.12.5058-5068.2005"},{"key":"e_1_2_1_27_2","doi-asserted-by":"publisher","DOI":"10.1086\/424465"},{"key":"e_1_2_1_28_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.46.11.3634-3636.2002"},{"key":"e_1_2_1_29_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.32.9.1331"},{"key":"e_1_2_1_30_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.48.9.3407-3411.2004"},{"key":"e_1_2_1_31_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.44.4.1108-1111.2000"},{"key":"e_1_2_1_32_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkh066"},{"key":"e_1_2_1_33_2","volume-title":"Reference method for broth dilution antifungal susceptibility testing of yeasts","author":"National Committee for Clinical Laboratory Standards.","year":"2002"},{"key":"e_1_2_1_34_2","volume-title":"Reference method for broth dilution antifungal susceptibility testing of conidium\u2010forming filamentous fungi","author":"National Committee for Clinical Laboratory Standards","year":"1998"},{"key":"e_1_2_1_35_2","volume-title":"Reference method for broth dilution antifungal susceptibility testing of filamentous fungi","author":"National Committee for Clinical Laboratory Standards.","year":"2002"},{"key":"e_1_2_1_36_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.42.8.3475-3482.2004"},{"key":"e_1_2_1_37_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.42.7.3117-3119.2004"},{"key":"e_1_2_1_38_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.45.1.327-330.2001"},{"key":"e_1_2_1_39_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.48.5.1912-1915.2004"},{"key":"e_1_2_1_40_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0732-8893(97)00246-0"},{"key":"e_1_2_1_41_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0732-8893(02)00507-2"},{"key":"e_1_2_1_42_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.46.6.1960-1965.2002"},{"key":"e_1_2_1_43_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.47.10.3149-3154.2003"},{"key":"e_1_2_1_44_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.43.11.5425-5427.2005"},{"key":"e_1_2_1_45_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.47.3.1068-1071.2003"},{"key":"e_1_2_1_46_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkh548"},{"key":"e_1_2_1_47_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.44.2.324-326.2006"},{"key":"e_1_2_1_48_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkf074"},{"key":"e_1_2_1_49_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.40.10.3841-3844.2002"},{"key":"e_1_2_1_50_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.47.8.2640-2643.2003"},{"key":"e_1_2_1_51_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.41.8.3623-3626.2003"},{"key":"e_1_2_1_52_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.45.12.3310-3321.2001"},{"key":"e_1_2_1_53_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.49.3.1232-1235.2005"},{"key":"e_1_2_1_54_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.49.8.3572-3574.2005"},{"key":"e_1_2_1_55_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.48.9.3279-3283.2004"},{"key":"e_1_2_1_56_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.49.7.2851-2856.2005"},{"key":"e_1_2_1_57_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.49.7.2994-2996.2005"},{"key":"e_1_2_1_58_2","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.7164\/antibiotics.53.1175","article-title":"In vitro antifungal activity of a novel lipopeptide antifungal agent, FK463, against various fungal pathogens","volume":"53","author":"Uchida K","year":"2000","journal-title":"J Antibiot"},{"key":"e_1_2_1_59_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.49.8.3498-3500.2005"},{"key":"e_1_2_1_60_2","doi-asserted-by":"publisher","DOI":"10.3314\/jjmm.45.101"},{"key":"e_1_2_1_61_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1439-0507.2005.01132.x"},{"key":"e_1_2_1_62_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.41.4.863"},{"key":"e_1_2_1_63_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.47.4.1376-1381.2003"},{"key":"e_1_2_1_64_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dki131"},{"key":"e_1_2_1_65_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2958.2003.03430.x"},{"key":"e_1_2_1_66_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.50.4.1148-1155.2006"},{"key":"e_1_2_1_67_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.41.11.2471"},{"key":"e_1_2_1_68_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.49.8.3264-3273.2005"},{"key":"e_1_2_1_69_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01653-05"},{"key":"e_1_2_1_70_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.49.2.767-769.2005"},{"key":"e_1_2_1_71_2","doi-asserted-by":"publisher","DOI":"10.1592\/phco.26.6.877"},{"key":"e_1_2_1_72_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.48.4.1382-1383.2004"},{"key":"e_1_2_1_73_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkl022"},{"key":"e_1_2_1_74_2","doi-asserted-by":"publisher","DOI":"10.1086\/500939"},{"key":"e_1_2_1_75_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00148-06"},{"key":"e_1_2_1_76_2","doi-asserted-by":"publisher","DOI":"10.1177\/0091270004265644"},{"key":"e_1_2_1_77_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.49.4.1331-1336.2005"},{"key":"e_1_2_1_78_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.46.3.739-745.2002"},{"key":"e_1_2_1_79_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10096-004-1228-z"},{"key":"e_1_2_1_80_2","doi-asserted-by":"publisher","DOI":"10.1177\/0091270004270146"},{"key":"e_1_2_1_81_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.49.11.4536-4545.2005"},{"key":"e_1_2_1_82_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.49.8.3317-3324.2005"},{"key":"e_1_2_1_83_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.50.2.632-638.2006"},{"key":"e_1_2_1_84_2","first-page":"853","volume-title":"Single dose caspofungin pharmacokinetics in healthy elderly subjects [abstr]","author":"Stone JA","year":"2000"},{"key":"e_1_2_1_85_2","doi-asserted-by":"publisher","DOI":"10.1177\/0091270004265644"},{"key":"e_1_2_1_86_2","first-page":"A30","volume-title":"Pharmacokinetics of FK463 a novel echinocandin analogue in elderly and non\u2010elderly subjects [abstr]","author":"Mukai T","year":"2001"},{"key":"e_1_2_1_87_2","first-page":"A14","volume-title":"Effect of hepatic insufficiency on the pharmacokinetics of caspofungin [abstr]","author":"Stone JA","year":"2001"},{"key":"e_1_2_1_88_2","doi-asserted-by":"publisher","DOI":"10.1177\/0091270005279580"},{"key":"e_1_2_1_89_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0168-8278(05)80500-8"},{"key":"e_1_2_1_90_2","first-page":"A34","volume-title":"Anidulafungin: pharmacokinetics in subjects with mild and moderate hepatic impairment [abstr]","author":"Thye D","year":"2001"},{"key":"e_1_2_1_91_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa021585"},{"key":"e_1_2_1_92_2","first-page":"M1308a","volume-title":"Comparison of micafungin and capsofungin for candidemia or invasive candidiasis [abstr]","author":"Betts RF","year":"2006"},{"key":"e_1_2_1_93_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10096-005-0024-8"},{"key":"e_1_2_1_94_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.48.6.2021-2024.2004"},{"key":"e_1_2_1_95_2","article-title":"A double\u2010blind, randomized, multi\u2010center study of the safety and efficacy of anidulafungin versus fluconazole in the treatment of patients with candidemia and other forms of invasive candidiasis","author":"Reboli AC","journal-title":"N Engl J Med"},{"key":"e_1_2_1_96_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.46.2.451-457.2002"},{"key":"e_1_2_1_97_2","doi-asserted-by":"publisher","DOI":"10.1086\/323401"},{"key":"e_1_2_1_98_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(02)01191-9"},{"key":"e_1_2_1_99_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2004.02083.x"},{"key":"e_1_2_1_100_2","doi-asserted-by":"publisher","DOI":"10.1086\/423377"},{"key":"e_1_2_1_101_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2005.02427.x"},{"key":"e_1_2_1_102_2","doi-asserted-by":"publisher","DOI":"10.1086\/423378"},{"key":"e_1_2_1_103_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa040446"},{"key":"e_1_2_1_104_2","doi-asserted-by":"publisher","DOI":"10.1086\/422312"},{"key":"e_1_2_1_105_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2004.05.011"},{"key":"e_1_2_1_106_2","doi-asserted-by":"publisher","DOI":"10.1086\/423381"},{"key":"e_1_2_1_107_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2006.03.003"},{"key":"e_1_2_1_108_2","doi-asserted-by":"publisher","DOI":"10.1080\/00365540410020406"},{"key":"e_1_2_1_109_2","doi-asserted-by":"publisher","DOI":"10.1086\/423380"},{"key":"e_1_2_1_110_2","first-page":"M882","volume-title":"Combination therapy of voriconazole and anidulafungin improves outcome of experimental pulmonary aspergillosis [abstr]","author":"Petraitis V","year":"2006"},{"key":"e_1_2_1_111_2","first-page":"M889","volume-title":"The combination of caspofungin and voriconazole as primary and salvage therapy of invasive aspergillosis in hematologic malignancy patients [abstr]","author":"Raad I","year":"2006"},{"key":"e_1_2_1_112_2","first-page":"M878","volume-title":"Micafungin alone or in combination with other licensed antifungal therapy in bone marrow transplant recipients with invasive aspergillosis [abstr]","author":"Kontoyiannis D","year":"2006"},{"key":"e_1_2_1_113_2","first-page":"M899","volume-title":"Impact of primary combination therapy on outcomes in invasive aspergillosis [abstr]","author":"Kubin CJ","year":"2006"},{"key":"e_1_2_1_114_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.48.11.4306-4314.2004"},{"key":"e_1_2_1_115_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-3062.2004.00065.x"},{"key":"e_1_2_1_116_2","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bmt.1704516"},{"key":"e_1_2_1_117_2","doi-asserted-by":"publisher","DOI":"10.1177\/0091270005281234"},{"key":"e_1_2_1_118_2","first-page":"A13","volume-title":"Drug interactions between caspofungin and tacrolimus [abstr]","author":"Stone J","year":"2001"},{"key":"e_1_2_1_119_2","doi-asserted-by":"publisher","DOI":"10.1177\/0091270005279274"}],"container-title":["Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1592%2Fphco.27.3.369","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/accpjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1592\/phco.27.3.369","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T14:44:21Z","timestamp":1761057861000},"score":1,"resource":{"primary":{"URL":"https:\/\/accpjournals.onlinelibrary.wiley.com\/doi\/10.1592\/phco.27.3.369"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2007,3]]},"references-count":118,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2007,3]]}},"alternative-id":["10.1592\/phco.27.3.369"],"URL":"https:\/\/doi.org\/10.1592\/phco.27.3.369","archive":["Portico"],"relation":{},"ISSN":["0277-0008","1875-9114"],"issn-type":[{"value":"0277-0008","type":"print"},{"value":"1875-9114","type":"electronic"}],"subject":[],"published":{"date-parts":[[2007,3]]},"assertion":[{"value":"2012-01-06","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}