A 60-year-old patient with Candida bloodstream infection and renal failure is started on caspofungin. Compared with fluconazole, which statement about echinocandins is MOST accurate?

• A Echinocandins are fungistatic against Candida and Aspergillus
• B Echinocandins inhibit beta-1,3-glucan synthase, disrupting the fungal cell wall ✓
• C Echinocandins require dose adjustment in renal failure
• D Echinocandins have excellent oral bioavailability

Explanation

Echinocandins (caspofungin, micafungin, anidulafungin) inhibit the enzyme beta-1,3-glucan synthase, thereby blocking synthesis of beta-1,3-glucan, a critical structural polymer of the fungal cell wall absent in mammalian cells. This confers a favorable toxicity profile. They are fungicidal against Candida and fungistatic against Aspergillus. They require hepatic (not renal) dose adjustment and are available only parenterally due to poor oral bioavailability.

Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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