Equinocandinas

Equinocandinas

Las equinocandinas son un grupo de agentes fungicidas que atacan la pared celular fúngica. Las equinocandinas inhiben la β-glucano sintasa, que a su vez inhibe la producción de β-glucano, un componente estructural clave de las paredes celulares de los LOS Neisseria hongos. Los LOS Neisseria tres medicamentos principales de esta clase incluyen caspofungina, micafungina y anidulafungina. Las equinocandinas se usan principalmente para tratar infecciones por Candida Candida Candida is a genus of dimorphic, opportunistic fungi. Candida albicans is part of the normal human flora and is the most common cause of candidiasis. The clinical presentation varies and can include localized mucocutaneous infections (e.g., oropharyngeal, esophageal, intertriginous, and vulvovaginal candidiasis) and invasive disease (e.g., candidemia, intraabdominal abscess, pericarditis, and meningitis). Candida/Candidiasis y Aspergillus Aspergillus A genus of mitosporic fungi containing about 100 species and eleven different teleomorphs in the family trichocomaceae. Echinocandins en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum personas que están gravemente enfermas o que tienen neutropenia Neutropenia Neutrophils are an important component of the immune system and play a significant role in the eradication of infections. Low numbers of circulating neutrophils, referred to as neutropenia, predispose the body to recurrent infections or sepsis, though patients can also be asymptomatic. Neutropenia. Aunque las equinocandinas tienen un espectro de actividad más estrecho que algunas otras clases de antimicóticos, son clínicamente útiles debido a sus perfiles de toxicidad relativamente bajos y significativamente menos interacciones farmacológicas que los LOS Neisseria azoles Azoles Azoles are a widely used class of antifungal medications inhibiting the production of ergosterol, a critical component in the fungal cell membrane. The 2 primary subclasses of azoles are the imidazoles, older agents typically only used for topical applications, and the triazoles, newer agents with a wide spectrum of uses. Azoles y la anfotericina B. La resistencia a las equinocandinas generalmente es poco común, pero está surgiendo en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum algunas cepas de C. glabrata, generalmente a través de mutaciones que reducen la afinidad de este medicamento por la β-glucano sintasa.

Last updated: Dec 15, 2025

Editorial responsibility: Stanley Oiseth, Lindsay Jones, Evelin Maza

Contents

Clasificación

Estructura Química y Farmacodinamia

Farmacocinética

Indicaciones

Efectos Secundarios y Contraindicaciones

Resistencia

Comparación de Medicamentos Antimicóticos

Referencias

Clasificación

Las equinocandinas son un grupo de agentes antifúngicos que se dirigen a la pared celular fúngica y se usan típicamente para tratar la candidiasis Candidiasis Candida is a genus of dimorphic, opportunistic fungi. Candida albicans is part of the normal human flora and is the most common cause of candidiasis. The clinical presentation varies and can include localized mucocutaneous infections (e.g., oropharyngeal, esophageal, intertriginous, and vulvovaginal candidiasis) and invasive disease (e.g., candidemia, intraabdominal abscess, pericarditis, and meningitis). Candida/Candidiasis invasiva en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum personas con neutropenia Neutropenia Neutrophils are an important component of the immune system and play a significant role in the eradication of infections. Low numbers of circulating neutrophils, referred to as neutropenia, predispose the body to recurrent infections or sepsis, though patients can also be asymptomatic. Neutropenia o que están gravemente enfermas.

Cuatro medicamentos de esta clase se utilizan actualmente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el aspecto clínico:
- Caspofungina
- Micafungina
- Anidulafungina
- Rezafungina
Beneficios clave de las equinocandinas sobre otras clases de medicamentos antimicóticos (p.ej.: azoles Azoles Azoles are a widely used class of antifungal medications inhibiting the production of ergosterol, a critical component in the fungal cell membrane. The 2 primary subclasses of azoles are the imidazoles, older agents typically only used for topical applications, and the triazoles, newer agents with a wide spectrum of uses. Azoles y anfotericina B):
- Bajo potencial de toxicidad renal o hepática
- Pocas interacciones farmacológicas graves

Estructura Química y Farmacodinamia

Estructura química

Grandes lipopéptidos cíclicos
El anillo grande está unido a una cadena larga de ácidos grasos que actúa como un ancla, manteniendo el medicamento en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum su lugar en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la membrana de la célula fúngica.
Moléculas grandes → poca penetración en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el LCR y el ojo, y baja disolución en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la orina

Chemical structure of caspofungin echinocandins — Estructura química de caspofungina
Imagen: “Caspofungin” por FEERERO. Licencia: Dominio Público

Estructura química de caspofungina
Imagen: “Caspofungin” por FEERERO. Licencia: Dominio Público

Mecanismo de acción

Las equinocandinas ejercen sus efectos al AL Amyloidosis inhibir la producción de la pared celular fúngica al AL Amyloidosis interferir con la síntesis de β-glucano, una importante componente estructural.

La pared celular fúngica se compone de tres capas primarias (de afuera hacia adentro):
- Proteínas
- β-glucanos:
  - Forma enlaces cruzados esenciales entre las proteínas de arriba y la quitina de abajo.
  - Constituyen aproximadamente del 30%‒60% de la masa de la pared celular en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum Candida Candida Candida is a genus of dimorphic, opportunistic fungi. Candida albicans is part of the normal human flora and is the most common cause of candidiasis. The clinical presentation varies and can include localized mucocutaneous infections (e.g., oropharyngeal, esophageal, intertriginous, and vulvovaginal candidiasis) and invasive disease (e.g., candidemia, intraabdominal abscess, pericarditis, and meningitis). Candida/Candidiasis spp.
- Quitina
Las equinocandinas inhiben la β-glucano sintasa, que es la enzima que sintetiza el β-glucano. La inhibición de esta enzima da como resultado:
- Deterioro de la capacidad del hongo para crear y/o mantener su pared celular
- Significativo ↑ en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la susceptibilidad de la célula fúngica a las fuerzas osmóticas → efecto fungicida
- Las equinocandinas tienen actividad fungistática contra la especie Aspergillus Aspergillus A genus of mitosporic fungi containing about 100 species and eleven different teleomorphs in the family trichocomaceae. Echinocandins
Genética:
- Las subunidades clave de la β-glucano sintasa están codificadas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria genes Genes A category of nucleic acid sequences that function as units of heredity and which code for the basic instructions for the development, reproduction, and maintenance of organisms. DNA Types and Structure FKS1 y FKS2.
- Las mutaciones en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum estos genes Genes A category of nucleic acid sequences that function as units of heredity and which code for the basic instructions for the development, reproduction, and maintenance of organisms. DNA Types and Structure pueden conducir a la resistencia a las equinocandinas.
El β-glucano y la β-glucano sintasa no se encuentran en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las células humanas → significativamente menos tóxicas que algunos otros agentes antifúngicos (p.ej.: anfotericina B)
La actividad de equinocandina complementa los LOS Neisseria efectos antifúngicos de otras clases de medicamentos → idoneidad en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum terapia combinada

Agentes antifúngicos y mecanismos de acción.
Imagen por Lecturio. Licencia: CC BY-NC-SA 4.0

Farmacocinética

Características comunes

Características comunes a los LOS Neisseria cuatro medicamentos de esta clase:

Mala absorción oral → solo formulaciones IV
Altos niveles de unión a proteínas
Mala penetración en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum:
- Ojos
- Sistema nervioso central
No se metabolizan significativamente por las enzimas del citocromo P450 (CYP450)
- No son inductores ni inhibidores significativos.
- La micafungina presenta interacciones menores.
No requieren ajustes de dosis en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum insuficiencia renal
La caspofungina requiere ajuste de dosis en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum caso de compromiso hepático
No dializable

Caspofungina

La caspofungina exhibe una farmacocinética no lineal, trifásica y complicada.

Absorción y distribución:
- La distribución tisular significativa conduce a una rápida disminución inicial de los LOS Neisseria niveles plasmáticos.
- A continuación, se produce una nueva liberación del medicamento desde el tejido extravascular.
- Altamente unido a proteínas
Metabolismo:
- Metabolismo hepático lento pero extenso (algo más rápido en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum individuos más jóvenes)
- Interactúa con la ciclosporina (aumenta el riesgo de hepatotoxicidad)
Excreción:
- Vida media:
  - Distribución: aproximadamente 10 horas
  - Terminal: 40‒50 horas
- Orina (40%), principalmente como metabolitos
- Heces (35%), principalmente como metabolitos
Relevancia clínica de la farmacocinética de caspofungina: requiere una dosis de carga seguida de una dosis más baja una vez al AL Amyloidosis día

Micafungina

La micafungina exhibe una farmacocinética lineal más predecible.

Metabolismo:
- Metabolismo hepático lento pero extenso (algo más rápido en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum individuos más jóvenes)
- Se somete a una hidroxilación menor por CYP3A
- Interfiere con el metabolismo de sirolimus Sirolimus A macrolide compound obtained from streptomyces hygroscopicus that acts by selectively blocking the transcriptional activation of cytokines thereby inhibiting cytokine production. It is bioactive only when bound to immunophilins. Sirolimus is a potent immunosuppressant and possesses both antifungal and antineoplastic properties. Immunosuppressants y ciclosporina
Excreción:
- Vida media: 11‒21 horas
- Principalmente fecal (71%)

Anidulafungina

La anidulafungina exhibe una farmacocinética lineal más predecible.

Metabolismo:
- Sin metabolismo hepático
- Sufre hidrólisis química lenta.
Excreción:
- Vida media: 40‒50 horas
- Heces (30%)

Rezafungina

La rezafungina presenta una farmacocinética lineal y predecible en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum todo el rango de dosis terapéuticas.

Metabolismo:
- No se metaboliza significativamente
- No inhibe ni induce significativamente las principales enzimas del citocromo P450 (CYP) ni es sustrato de ellas, lo que indica una baja probabilidad de interacciones farmacológicas mediadas por CYP.
Excreción:
- Semivida terminal muy larga, ~130-150 horas
- Se excreta principalmente sin cambios en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las heces, con una cantidad mínima en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la orina.
- No dializable
Relevancia clínica de la farmacocinética:
- Requiere una dosis de carga inicial seguida de una administración intravenosa semanal debido a su larga semivida.
- No es necesario ajustar la dosis en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes con insuficiencia renal o hepática.

Indicaciones

Las equinocandinas son generalmente intercambiables con respecto a su actividad e indicaciones.

Espectro de actividad

Activo contra:
- Cándida spp., incluidas algunas cepas de C. glabrata y C. krusei resistentes a fluconazol
- Aspergillus Aspergillus A genus of mitosporic fungi containing about 100 species and eleven different teleomorphs in the family trichocomaceae. Echinocandins spp.
Cierta actividad contra micosis endémicas (aunque generalmente no es adecuada como tratamiento efectivo):
- Blastomicosis
- Histoplasmosis Histoplasmosis Histoplasmosis is an infection caused by Histoplasma capsulatum, a dimorphic fungus. Transmission is through inhalation, and exposure to soils containing bird or bat droppings increases the risk of infection. Most infections are asymptomatic; however, immunocompromised individuals generally develop acute pulmonary infection, chronic infection, or even disseminated disease. Histoplasma/Histoplasmosis
- Coccidioidomicosis
Sin actividad significativa contra:
- Cryptococcus Cryptococcus Cryptococcosis is an opportunistic, fungal infection caused by the Cryptococcus species. The principal pathogens in humans are C. neoformans (primary) and C. gattii. Cryptococcus neoformans is typically found in pigeon droppings and acquired by inhaling dust from contaminated soil. The majority of affected patients are immunocompromised. Cryptococcus/Cryptococcosis spp.
- Mucorales Mucorales Mucormycosis is an angioinvasive fungal infection caused by multiple fungi within the order, Mucorales. The fungi are ubiquitous in the environment, but mucormycosis is very rare and almost always occurs in patients who are immunocompromised. Inhalation of fungal spores can cause rhinocerebral or pulmonary mucormycosis, direct inoculation can cause cutaneous mucormycosis, and ingestion can cause gastrointestinal mucormycosis. Mucorales/Mucormycosis (causante de mucormicosis)

Usos clínicos

Las equinocandinas se usan más comúnmente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum personas con neutropenia Neutropenia Neutrophils are an important component of the immune system and play a significant role in the eradication of infections. Low numbers of circulating neutrophils, referred to as neutropenia, predispose the body to recurrent infections or sepsis, though patients can also be asymptomatic. Neutropenia o infecciones por Candida Candida Candida is a genus of dimorphic, opportunistic fungi. Candida albicans is part of the normal human flora and is the most common cause of candidiasis. The clinical presentation varies and can include localized mucocutaneous infections (e.g., oropharyngeal, esophageal, intertriginous, and vulvovaginal candidiasis) and invasive disease (e.g., candidemia, intraabdominal abscess, pericarditis, and meningitis). Candida/Candidiasis.

Candidiasis Candidiasis Candida is a genus of dimorphic, opportunistic fungi. Candida albicans is part of the normal human flora and is the most common cause of candidiasis. The clinical presentation varies and can include localized mucocutaneous infections (e.g., oropharyngeal, esophageal, intertriginous, and vulvovaginal candidiasis) and invasive disease (e.g., candidemia, intraabdominal abscess, pericarditis, and meningitis). Candida/Candidiasis:
- Esofágico
- Enfermedad orofaríngea refractaria
- Biopelículas de Cándida spp
- Candidemia y enfermedad diseminada
- Absceso intraabdominal, peritonitis Peritonitis Inflammation of the peritoneum lining the abdominal cavity as the result of infectious, autoimmune, or chemical processes. Primary peritonitis is due to infection of the peritoneal cavity via hematogenous or lymphatic spread and without intra-abdominal source. Secondary peritonitis arises from the abdominal cavity itself through rupture or abscess of intra-abdominal organs. Penetrating Abdominal Injury e infecciones del espacio pleural
Profilaxis fúngica en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum individuos con neutropenia Neutropenia Neutrophils are an important component of the immune system and play a significant role in the eradication of infections. Low numbers of circulating neutrophils, referred to as neutropenia, predispose the body to recurrent infections or sepsis, though patients can also be asymptomatic. Neutropenia y cáncer
Neutropenia Neutropenia Neutrophils are an important component of the immune system and play a significant role in the eradication of infections. Low numbers of circulating neutrophils, referred to as neutropenia, predispose the body to recurrent infections or sepsis, though patients can also be asymptomatic. Neutropenia febril (terapia empírica, generalmente preferida a la anfotericina B)
Terapia de rescate en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum aspergilosis invasiva

Efectos Secundarios y Contraindicaciones

Efectos secundarios

Las equinocandinas son generalmente muy bien toleradas y tienen baja toxicidad en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum comparación con otros agentes antifúngicos. Los LOS Neisseria efectos secundarios, si se observan, pueden incluir:

Fiebre
Efectos secundarios gastrointestinales menores: náuseas, vómitos y/o diarrea
Reacción/flebitis en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el lugar de la perfusión
Reacciones a la infusión (generalmente con infusión rápida):
- Broncoespasmo y disnea
- Enrojecimiento
- Hipotensión
- Urticaria Urticaria Urticaria is raised, well-circumscribed areas (wheals) of edema (swelling) and erythema (redness) involving the dermis and epidermis with associated pruritus (itch). Urticaria is not a single disease but rather is a reaction pattern representing cutaneous mast cell degranulation. Urticaria (Hives), prurito y/o exantema
Hipopotasemia
Anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types, leucopenia, trombocitopenia
Hepatotoxicidad (raro):
- ↑ En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum transaminasas
- Disfunción hepática (extremadamente rara): hepatitis y/o insuficiencia hepática

Contraindicaciones

Hipersensibilidad a las equinocandinas
Sospecha de intolerancia hereditaria a la fructosa (ya que las formulaciones de anidulafungina contienen fructosa)

Resistencia

La resistencia en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la mayoría de Candida Candida Candida is a genus of dimorphic, opportunistic fungi. Candida albicans is part of the normal human flora and is the most common cause of candidiasis. The clinical presentation varies and can include localized mucocutaneous infections (e.g., oropharyngeal, esophageal, intertriginous, and vulvovaginal candidiasis) and invasive disease (e.g., candidemia, intraabdominal abscess, pericarditis, and meningitis). Candida/Candidiasis spp. es raro, pero posible.
La excepción es con C. glabrata:
- ↑ Resistencia en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum algunas cepas que también son resistentes a fluconazol y voriconazol
- La resistencia puede ser tan alta como 12%.
El mecanismo principal de resistencia es una mutación en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el gen FKS → ↓ afinidad de las equinocandinas por su diana, la β-glucano sintasa

Comparación de Medicamentos Antimicóticos

**Tabla: Comparación de medicamentos antimicóticos**
Clase del medicamento (ejemplos)	Mecanismo de acción	Relevancia clínica
Azoles Azoles Azoles are a widely used class of antifungal medications inhibiting the production of ergosterol, a critical component in the fungal cell membrane. The 2 primary subclasses of azoles are the imidazoles, older agents typically only used for topical applications, and the triazoles, newer agents with a wide spectrum of uses. Azoles (fluconazol, voriconazol)	Inhibe la producción de ergosterol Ergosterol A steroid occurring in fungi. Irradiation with ultraviolet rays results in formation of ergocalciferol (vitamin d2). Azoles (un componente crítico de la membrana celular fúngica) al AL Amyloidosis bloquear la enzima lanosterol Lanosterol A triterpene that derives from the chair-boat-chair-boat folding of 2, 3-oxidosqualene. It is metabolized to cholesterol and cucurbitacins. Cholesterol Metabolism 14-α-desmetilasa	Antifúngicos ampliamente utilizados con un espectro de actividad relativamente amplio Muchas interacciones de medicamento a medicamento debido a los LOS Neisseria efectos sobre el sistema CYP450 Hepatotoxicidad En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum general menos tóxico que la anfotericina B
Polienos (anfotericina B, nistatina)	Se une al AL Amyloidosis ergosterol Ergosterol A steroid occurring in fungi. Irradiation with ultraviolet rays results in formation of ergocalciferol (vitamin d2). Azoles en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la membrana celular fúngica creando poros artificiales en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la membrana → da como resultado la fuga de componentes celulares y conduce a la lisis celular (muerte)	Anfotericina B: Reservado para infecciones fúngicas potencialmente mortales Amplio espectro de actividad Relativamente ↑ toxicidad (especialmente nefrotoxicidad) Nistatina: Solo uso tópico: piel, membranas mucosas, luz GI
Equinocandinas (caspofungina, micafungina, anidulafungina)	Inhibe la β-glucano sintasa (la enzima que sintetiza el β-glucano y un componente estructural importante de la pared celular fúngica) → pared celular debilitada → lisis celular	Trata las infecciones por Candida Candida Candida is a genus of dimorphic, opportunistic fungi. Candida albicans is part of the normal human flora and is the most common cause of candidiasis. The clinical presentation varies and can include localized mucocutaneous infections (e.g., oropharyngeal, esophageal, intertriginous, and vulvovaginal candidiasis) and invasive disease (e.g., candidemia, intraabdominal abscess, pericarditis, and meningitis). Candida/Candidiasis y Aspergillus Aspergillus A genus of mitosporic fungi containing about 100 species and eleven different teleomorphs in the family trichocomaceae. Echinocandins en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes críticos y neutropénicos Toxicidad mínima Interacciones mínimas de medicamento a medicamento
Griseofulvina	Se une a la queratina en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la piel recién formada, lo que hace HACE Altitude Sickness que las células humanas sean resistentes a la invasión → con el tiempo, las nuevas estructuras de cabello/piel/uñas no infectadas reemplazan las viejas estructuras infectadas Inhibe el ensamblaje de microtúbulos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum dermatofitos → inhibe la replicación de células fúngicas	Trata las infecciones por dermatofitos del cabello, la piel y las uñas. Solo medicación oral (no tópicamente activa) Afecta el sistema CYP450 (más interacciones de medicamento a medicamento) Reemplazado en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum gran medida por agentes más nuevos (e.g., terbinafina)
Terbinafina	Inhibe la enzima escualeno epoxidasa → bloquea la producción de epóxido de escualeno, que es un precursor del ergosterol Ergosterol A steroid occurring in fungi. Irradiation with ultraviolet rays results in formation of ergocalciferol (vitamin d2). Azoles y un componente crítico de la membrana celular	Trata las infecciones por dermatofitos del cabello, la piel y las uñas. Agente de elección para la onicomicosis Toxicidad relativamente baja
Flucitosina	Un análogo de pirimidina con metabolitos: Compitiendo con el uracilo e interrumpiendo la síntesis de ARN Inhibe irreversiblemente la timidilato sintasa → el hongo es incapaz de sintetizar o corregir el ADN	Siempre utilizado en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum combinación con otros agentes debido a: Efectos sinérgicos positivos ↑ Resistencia con monoterapia Principales indicaciones: Meningitis Meningitis Meningitis is inflammation of the meninges, the protective membranes of the brain, and spinal cord. The causes of meningitis are varied, with the most common being bacterial or viral infection. The classic presentation of meningitis is a triad of fever, altered mental status, and nuchal rigidity. Meningitis criptocócica Cromoblastomicosis Toxicidad: mielosupresión

Referencias

Sheppard, D., Lampiris, H.W. (2012). Antifungal Agents. In Katzung, B.G., Masters, S.B., Trevor, A.J. (Eds.), Basic and Clinical Pharmacology (12th Ed., pp. 855).
Smith, H. L., Bensman, T. J., Mishra, S., et al. (2024). Regulatory considerations in the approval of rezafungin (rezzayo) for the treatment of candidemia and invasive candidiasis in adults. The Journal of Infectious Diseases, 230(2), 505–513. https://doi.org/10.1093/infdis/jiae146
Lewis, R. E. (2023). Pharmacology of echinocandins and other glucan synthesis inhibitors. UpToDate. Retrieved April 11, 2025, from https://www.uptodate.com/contents/pharmacology-of-echinocandins-and-other-glucan-synthesis-inhibitors
Andes, D., Brüggemann, R. J., Flanagan, S., Lepak, A. J., Lewis, R. E., Ong, V., Rubino, C. M., & Sandison, T. (2024). The distinctive pharmacokinetic profile of rezafungin, a long-acting echinocandin developed in the era of modern pharmacometrics. Journal of Antimicrobial Chemotherapy, 80(1), 18–28. https://doi.org/10.1093/jac/dkae415
U.S. Food and Drug Administration. (2023). Integrated review: NDA 217417, Rezafungin (rezafungin for injection). https://www.accessdata.fda.gov/drugsatfda_docs/nda/2023/217417Orig1s000IntegratedR.pdf
Nivoix, Y., Ledoux, M., Herbrecht, R. (2020). Antifungal therapy: New and evolving therapies. Semin Respir Crit Care Med. 2020; 41, 158-174. Retrieved April 11, 2025, from https://www.medscape.com/viewarticle/924712_5
Fotsing, L.D. (2024). Caspofungin. StatPearls. Retrieved April 11, 2025, from https://www.statpearls.com/articlelibrary/viewarticle/45651/
Lexicomp Drug Information Sheets (2025). In UpToDate. Retrieved April 11, 2025, from:
- Caspofungin, https://www.uptodate.com/contents/caspofungin-drug-information
- Micafungin, https://www.uptodate.com/contents/micafungin-drug-information
- Anidulafungin, https://www.uptodate.com/contents/anidulafungin-drug-information

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