Medicine & USMLE


  1. Amphotericin B
  2. Nystatin
  3. Flucytosine
  4. Azoles
  5. Terbinafine
  6. Echinocandins
  7. Griseofulvin


Echinocandins are a class of antifungals which include caspofungin and micafungin. Echinocandins inhibit beta glucan to prevent fungal cell wall synthesis. These drugs are used to treat serious aspergillus and candida infections. Remember to watch out for liver toxicity in your patients.

Key Points

  • Echinocandins
    • Drug Names
      • Caspofungin
      • Micafungin
      • Anidulafungin
    • Mechanism
      • Inhibits synthesis of beta-glucan to block fungal cell wall synthesis
        • Beta-glucans are needed for cell wall cross-linking in Aspergillus and Candida
        • Note: targets fungal wall, not fungal membrane
    • Clinical Use
      • Invasive aspergillus
      • Candida
    • Adverse Effects
      • Hepatotoxicity
        • Elevation of AST and ALT seen in 7-14% of patients
      • GI upset
        • Seen in 1-3% of patients; usually mild
      • Infusion-associated hypersensitivity
        • Rash, hypotension, bronchospasm, and angioedema rarely occur due to local histamine release