Echinocandins: a wealth of choice – how clinically different are they?

PURPOSE OF REVIEW: The recent decade has been a 'golden age' for antifungal therapy. The introduction of a novel class of antifungals, the echinocandins, has revolutionized the therapy for invasive candidiasis, provided increasing options for antifungal prophylaxis in high-risk patients and energized the debate regarding combination antifungal therapy for invasive mycoses. RECENT FINDINGS: Randomized, controlled data exist for each echinocandin in the treatment of invasive candidiasis, and experts largely believe the agents to be equivalent in this setting. Future trials of combined echinocandin-triazole therapy for invasive aspergillosis are desired. Additionally, maximal dosing limitations are being pursued. SUMMARY: The echinocandins as a class offer an advance in the treatment of invasive candidiasis, an additional option for prophylaxis and an attractive choice for the study of combination antifungal therapy. Particularly for the major indication (treatment of invasive candidiasis), major clinical differences between agents have not been noted.