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Echinocandins

Echinocandins are approved intravenous antifungals that inhibit fungal cell-wall glucan synthesis. The class includes caspofungin, micafungin, anidulafungin, and rezafungin. Indications, age ranges, formulation limits, and exposure differ; they should not be presented as interchangeable treatments for every fungal infection.

Also known as Caspofungin · Micafungin · Anidulafungin · Rezafungin · Cancidas · Mycamine · Eraxis · Rezzayo

Approved medicine · see jurisdictionEstablished clinical evidenceHeart & circulationImmune system
AI-assisted source review · 2026-10-274 cited sources2 min read

At a glance

MembersCaspofungin, micafungin, anidulafungin, rezafungin
TargetBeta-(1,3)-D-glucan synthesis
RouteIntravenous
Core clinical roleSelected invasive Candida infections
Longer-acting memberRezafungin
Key limitationSpecies and infection-site differences

Overview

Echinocandins target a fungal structure that human cells do not possess, making them useful systemic antifungals, especially for Candida infections. This group entry covers all four members separately enough to preserve their clinical differences. Caspofungin includes empirical treatment in febrile neutropenia and salvage invasive-aspergillosis uses. Micafungin includes Candida treatment and prophylaxis in specified stem-cell-transplant settings. Anidulafungin covers defined invasive Candida and esophageal infections. Rezafungin has prolonged exposure and a restricted candidemia/invasive-candidiasis indication for patients with limited alternatives. Drug selection also depends on organism identification, resistance, infection location, age, liver function, and the particular formulation available.

Supporting sources [1] [2] [3] [4]

How it works

These medicines inhibit the fungal beta-(1,3)-D-glucan synthase complex, reducing an essential cell-wall component. The damaged wall limits fungal growth or survival. Activity varies by species and can be reduced by resistance-associated changes in glucan-synthase genes. The shared target does not ensure adequate exposure in the eye, central nervous system, or urine, and it does not make echinocandins appropriate for all molds or yeasts.

Supporting sources [1] [2] [3] [4]

Caspofungin and micafungin

Caspofungin labeling includes candidemia and selected other Candida infections, esophageal candidiasis, empirical treatment in febrile neutropenia, and invasive aspergillosis refractory to or intolerant of other therapy. Micafungin includes invasive Candida treatment, esophageal candidiasis, and specified prophylaxis. Pediatric and neonatal restrictions depend on disease and formulation; a class name alone is insufficient.

Supporting sources [1] [2]

Anidulafungin and rezafungin

Anidulafungin is approved for specified invasive Candida infections from one month of age and esophageal candidiasis in adults, with important evidence gaps for certain deep sites. Current rezafungin labeling covers candidemia and invasive candidiasis from age 12 when alternatives are limited or unavailable, based on limited clinical data. Its prolonged exposure distinguishes its administration pattern.

Supporting sources [3] [4]

Shared and member-specific precautions

Hypersensitivity and infusion reactions can occur across the class, and liver abnormalities require attention. Individual labels add distinctions: micafungin includes renal and hematologic warnings, anidulafungin has excipient-related precautions, and rezafungin includes photosensitivity. Approved products require separate review rather than treating one member’s adverse-event profile as the complete class profile.

Supporting sources [1] [2] [3] [4]

Are these appropriate for any fungal infection?

No. Susceptibility, source control, species, and site all matter. The labels identify limited evidence for infections such as Candida meningitis, osteomyelitis, or endocarditis in particular products. A drug’s activity against Candida in blood does not prove effectiveness for an unrelated mold, a superficial condition, or an infection in a poorly penetrated compartment.

Supporting sources [1] [3] [4]

Reading this profile

Jurisdiction: United States; indications and availability vary by formulation and country.. Molecular class: Class of cyclic lipopeptide antifungal medicines.

This profile was written with AI-assisted research and checked against the linked sources. It has not been represented as a clinician’s review. Evidence summaries describe the cited studies and products; they do not establish that a separately purchased preparation is equivalent.

Sources & references

Follow the original material. Product labels define specific formulations and uses; trial registration describes a study and does not by itself establish benefit.

  1. Cancidas / caspofungin — US prescribing information ↗
    Regulatory source · Checked 2026-10-27
  2. Micafungin — US prescribing information ↗
    Regulatory source · Checked 2026-10-27
  3. Eraxis / anidulafungin — US prescribing information ↗
    Regulatory source · Checked 2026-10-27
  4. Rezzayo / rezafungin — current US prescribing information ↗
    Regulatory source · Checked 2026-10-27
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