ID:IOTS - Infectious Disease Insight Of Two Specialists 132. Echinocandins Part 1: the old stuff
Feb 23, 2026
Tihana Bicanic, infectious diseases clinician and medical mycology expert, joins to unpack echinocandins. They cover what echinocandins are and how they work. Short talks on clinical impact for candidemia, limited activity against other fungi, dosing differences, pharmacokinetics, resistance via FKS mutations, species-specific susceptibility, side effects, and stewardship approaches.
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Echinocandin Mechanism And Origin
- Echinocandins inhibit fungal cell wall synthesis by blocking beta-1,3-D-glucan synthase.
- They are fungicidal against Candida and derived from fungal fermentation products like anidulofungin from Aspergillus nidulans.
Faster Blood Clearance Matters In Candidemia
- Faster fungicidal activity of echinocandins shortens time to blood culture clearance versus fluconazole.
- Anidulofungin converted blood cultures in ~2 days vs ~5 days for fluconazole, reducing metastatic complications.
Prefer Echinocandins First Line Except CNS
- Use echinocandins as first-line therapy for candidemia and invasive candidiasis except CNS/ocular disease due to poor penetration.
- Choose anidulofungin for severe hepatic impairment since it's not hepatically metabolized.