Echinocandins in antifungal pharmacotherapy

Patil, Abhay; Majumdar, Soumyajit

doi:10.1111/jphp.12780

Cited by 111 publications

(102 citation statements)

References 215 publications

(257 reference statements)

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“…Polyenes bind to ergosterol, thus reducing plasma membrane integrity (Ali Malayeri et al 2018). Echinocandins comprise a class of cell wall interfering agents that inhibit b-glucan synthase (Patil and Majumdar 2017). The pyrimidine analogue 5-fluorocytosine inhibits DNA and RNA synthesis, leading to defects in cell division and protein synthesis (Dietz et al 2019).…”

Section: Limited Cellular Targets and Side Effects Of Available Antifmentioning

confidence: 99%

Major challenges and perspectives in the diagnostics and treatment of dermatophyte infections

2020

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Dermatophytes are the aetiological factors of a majority of superficial fungal infections. What distinguishes them from other pathogenic filamentous fungi is their unique ability to degrade keratin. The remarkable ability of this group of fungi to survive in different ecosystems results from their morphological and ecological diversity as well as high adaptability to changing environmental conditions. Paradoxically, despite the progress in medicine, the prevalence of dermatophyte infections is increasing from year to year. At the beginning of the third millennium, practical diagnostic and therapeutic options are still very limited. This review focuses on understanding the major problems in this aspect of dermatophyte infections and indicates future strategies and perspectives for novel approaches to identification and drugs for elimination of dermatophytes. Particular importance is placed on development of a strategy for a diagnostic pathway and implementation of rapid and reliable diagnostics methods designed by international teams. Furthermore, among compounds that currently arouse great interest, representatives of terpenoids, alkaloids, saponins, flavonoids and essential oils deserve attention. Many of these compounds are undergoing clinical trials as potential antifungal agents, and future research should focus on attempts at determination of the applicability of tested substances. Finally, the advantages and disadvantages in implementation of new diagnostic paths and medicinal substances for routine use are indicated. Journal of Applied Microbiology

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Section: Limited Cellular Targets and Side Effects Of Available Antifmentioning

confidence: 99%

Major challenges and perspectives in the diagnostics and treatment of dermatophyte infections

2020

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“…Echinocandins (Caspofungin, Micafungin, and Anidulafungin), another class of antifungals, show some efficacy to control IPA. 86,87 The reported side effects of the drugs are scarce and the tolerance exhibits a favorable profile. 87 Another advantage of this antifungal class is that no dose adjustment is needed for age > 18 years, race, gender, renal impairment, or hemodialysis, although the dosage of 35 mg/d after a full loading dose is proposed when moderate hepatic insufficiency is present.…”

Section: Curative Treatmentsmentioning

confidence: 99%

Invasive Pulmonary Aspergillosis in Chronic Obstructive Pulmonary Disease Exacerbations

Bulpa

Duplaquet

Dimοpoulos

et al. 2020

Semin Respir Crit Care Med

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Nowadays, reports in the literature support that patients with severe chronic obstructive pulmonary disease (COPD) are at higher risk to develop invasive pulmonary aspergillosis (IPA). However, the interpretation of Aspergillus-positive cultures from the airways in critically ill COPD is still a challenge. Indeed, as the patient could be merely colonized, tissue samples are required to ascertain IPA diagnosis but they are rarely obtained before death. Consequently, diagnosis is often only suspected on the basis of a combination of three elements: clinical characteristics, radiological images (mostly thoracic CT scan), and microbiological, and occasionally serological, results. To facilitate the analysis of these data, several algorithms have been developed, and the best effectiveness has been demonstrated by the Clinical algorithm. This is of importance as IPA prognosis in these patients remains presently very poor and using such an algorithm could promote prompter diagnosis, early initiation of treatment, and subsequently improved outcome.While the most classical presentation of IPA in critically ill COPD patients features a combination of obstructive respiratory failure, antibiotic-resistant pneumonia, recent or chronic corticosteroid therapy, and positive Aspergillus cultures from the lower respiratory tract, the present article will also address less typical presentations and discuss the most appropriate treatments which could alter prognosis.

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“…On the other hand, echinocandins, which were developedin the early 2000s, are also frequently used in the treatment of invasive mycoses (including aspergillosis)due to their low host toxicity and good efficacy, especially as salvage therapy for invasive aspergillosis [9] .The three echinocandins, caspofungin, micafungin and anidulafungin, were the first antifungals that were created to selectively target the fungal cell wall. Echinocandinscause disruption in the b-(1,3)-D-glucan synthesis andincrease permeability of cell wall that leads to adisbalance of the intracellular osmotic pressure of the fungal cell and the fungal cell lysis [10] .…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of triazoles versus echinocandins in the treatment of invasive aspergillosis: A meta-analysis

et al. 2020

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Backgroun /Aim. Although majority of guidelines recommend triazoles (voriconazole, posaconazole, itraconazoleand isavuconazole) as first-line therapeutic option for treatment of invasive aspergillosis, echinocandins (caspofungin, micafungin and anidulafungin) are also used for this purpose. However, head-to-head comparison of triazoles and echinocandins for invasive aspergillosiswas rarely target of clinical trials. The aim of this meta-analysis was to compare efficacy and safety of triazoles and echinocandins when used for treatment of patients with invasive aspergillosis. Methods. This meta-analysis was based on systematic search of literature and selection of high-quality evidence according to pre-set inclusion and exclusion criteria. The literature search was made for comparison of treatment with any of triazoles (isavuconazole, itraconazole, posaconazole or voriconazole) versus any of echinocandins (caspofungin, anidulafungin or micafungin). The effects of triazoles (itraconazole, posaconazole or voriconazole) and echinocandins(caspofungin, anidulafungin or micafungin) were summarized using RevMan 5.3.5 software, and heterogeneity assessed by the Cochrane Q test and I² values. Several types of bias were assessed, and publication bias shown by Funnel plot and Egger's regression. Results. Two clinical trials and three cohort studies were included in this meta-analysis. Mortality in patients with invasive aspergillosis who were treated with triazoles was significantly lower than in patients treated with echinocandins (odds ratio 0.29 [0.13, 0.67]), and rate of favorable response (overall treatment success) 12 weeks after the therapy onset was higher in patients treated with triazoles (3.05 [1.52, 6.13]). On the other hand, incidence of adverse events was higher with triazoles than with echinocandins in patients treated for invasive aspergillosis (3.75 [0.89, 15.76]), although this difference was not significant. Conclusion.Triazoles (voriconazole in the first place) could be considered as more effective and somewhat less safe therapeutic option than echinocandins for invasive aspergillosis; however, due to poor quality of studies included in this meta-analysis definite conclusion should await results of additional, well designed clinical trials.

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Echinocandins in antifungal pharmacotherapy

Cited by 111 publications

References 215 publications

Major challenges and perspectives in the diagnostics and treatment of dermatophyte infections

Major challenges and perspectives in the diagnostics and treatment of dermatophyte infections

Invasive Pulmonary Aspergillosis in Chronic Obstructive Pulmonary Disease Exacerbations

Efficacy and safety of triazoles versus echinocandins in the treatment of invasive aspergillosis: A meta-analysis

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