Caspofungine, place dans les stratégies thérapeutiques antifongiques

Abstract

Caspofungin is an antifungal agent belonging to a new class of antifungal agents, the echinocandins. Its low oral bioavailability leads to a parenteral administration. Caspofungin has in vitro activity against most Candida spp. (including azole-resistant species, regardless of the mechanism of azole resistance) and Aspergillus spp. In France, indications are invasive candidiasis in adults without neutropenia and invasive aspergillosis when amphotericin B deoxycholate, lipid-associated formulations of amphotericin B or itraconazole failed or are associated with serious adverse effects. According to recent trials, it is possible that caspofungin becomes a suitable choice for initial therapy of candidemia or disseminated candidiasis in adults infected with an unspeciated isolate for which fluconazole activity is unknown. Similarly, caspofungin could be used for treatment of invasive aspergillosis, when pulmonary involvement is bilateral and/or rapidly extensive, in combination with voriconazole or lipid-associated formulations of amphotericin B. Finally, its efficacy for empirical antifungal therapy of persistently febrile neutropenic patients has been recently reported. Consequently, such a therapy could represent an alternative to lipid-associated formulations of amphotericin B.