Caspofungin

Cancidas

Caspofungin is a semisynthetic echinocandin, the first of a class of antifungal drugs that attack fungi where human cells offer no equivalent target: the cell wall. It is a cyclic lipopeptide — a ring-shaped peptide core with a lipid tail — that inhibits the enzyme β-(1,3)-D-glucan synthase. That enzyme builds β-(1,3)-D-glucan, a structural polymer essential to the fungal cell wall. Blocking it leaves the wall weak and unable to withstand osmotic pressure, so susceptible fungi die. Because human cells have no cell wall and make no β-glucan, echinocandins are generally well tolerated, an important advantage over older antifungals. Caspofungin is given intravenously and is used for serious, invasive fungal infections: candidemia and other forms of invasive candidiasis (including intra-abdominal abscesses and infected fluid collections), esophageal candidiasis, empiric antifungal therapy in patients with persistent fever and low white-cell counts (febrile neutropenia), and invasive aspergillosis in patients who cannot tolerate or have not responded to other therapies. It is fungicidal against many Candida species and fungistatic against Aspergillus. Within its class, caspofungin is a well-established option; micafungin and anidulafungin are the other approved echinocandins, and rezafungin is a newer, long-acting member. Echinocandins are recommended as first-line therapy for many invasive Candida infections. They are large molecules given only intravenously, do not penetrate the central nervous system or urine well (limiting their use in some infection sites), and caspofungin requires dose adjustment in significant liver impairment. Caspofungin is a prescription hospital medicine used under specialist (often infectious-disease) guidance; it is not a topical or over-the-counter antifungal.