Current role of echinocandins in the management of invasive aspergillosis.

Echinocandins are parenteral antifungals with a unique site of action targeting the cell wall synthesis. There are three molecules available, anidulafungin, caspofungin, and micafungin, which have fungicidal and fungistatic activity against Candida and Aspergillus, respectively, and an excellent safety profile. There is consistent proof of clinical activity against Aspergillus for caspofungin, while less is known for micafungin and even lees for anidulafungin. Micafungin and caspofungin have been successfully used in targeted treatment of aspergillosis, prophylaxis, and empirical therapy, both as monotherapy and in combination with other antifungals. Caspofungin is approved for empirical therapy of febrile neutropenia and salvage treatment of invasive aspergillosis, whereas micafungin is only licensed for antifungal prophylaxis in stem cell transplantation.