Overview

• Class of antifungal drugs that inhibit fungal cell wall synthesis
• All are semisynthetic derivatives of a fungal fermentation product (Aspergillus nidulans for anidulafungin)
• Good side-effect profile
• Potent biofilm activity
• Can only be given IV which limits their utility

Antifungal drugs in this class

• Caspofungin
• Micafungin
• Anidulafungin
• New: Rezafungin - approved by MHRA in 2024 for treatment of invasive candidiasis

Mechanism of action

Inhibit the synthesis of β-D-glucan, a major fungal cell wall component, by inhibiting the enzyme 1,3 β-D glucan synthase

• Fungicidal against Candida spp. → cause cell lysis and cell death
• Fungistatic against Aspergillus
• Some activity against Pneumocystis jirovecii – however, β-D-glucan is only found in the cyst form (not the trophic form) so cannot achieve clearance of infection
  • Has been used as adjunct in case reports

Spectrum of activity

• Candida - potent against Candida spp. including in biofilm