The antifungal activity of caspofungin in combination with antifungals or non-antifungals against Candida species in vitro and in clinical therapy

ABSTRACT

Introduction

Candida species have been regarded as global health threats due to their ability to cause invasive infections. It is challenging to treat Candida bloodstream infections, which are associated with high mortality levels. Monotherapy with antifungals is sometimes not effective against severe Candida infections, and combination therapy is needed in clinical practice.

Areas covered

This review was undertaken based on data from a PubMed search for English language reports published before March 2021 by using the terms ‘caspofungin,’ ‘Candida species,’ ‘combination therapy,’ ‘antifungal effect,’ and ‘novel antifungal agent.’

Expert opinion

Combination therapy is an empirical strategy for treating refractory Candida infections. Caspofungin has been recommended to treat candidaemia. Caspofungin in combination therapy has some applications, while the efficacy of combination therapy in the treatment of refractory Candida infections needs more study, such as randomized controlled trials. In addition, novel compounds or drugs with potential antifungal activities have been examined, and some of them exhibit synergistic interactions with caspofungin. Thus, the antifungal activity of caspofungin in combination with antifungals or non-antifungals against Candida species in vitro and in clinical therapy is summarized.

KEYWORDS:

• Combination therapy
• caspofungin
• candida species
• antifungal effect
• potential antifungal agents

Article highlights

• Combination therapies have been carried out empirically in clinical settings. The efficacy of these combination therapies and whether they can address the difficulties in treating refractory Candida infections needs to be determined.

• The combination of caspofungin and other antifungals can exhibit synergistic activity against Candida species in vitro.

• The combination therapies of caspofungin and other antifungals have antifungal effects when refractory or severe life-threatening infections occur, for example, candidemia, osteomyelitis, complicated urinary tract infections and complicated intra-abdominal infections.

• A series of non-antifungals can improve the antifungal activity of caspofungin in vitro and could provide new insights for developing novel antifungal drugs.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This work was supported by the Beijing Health Alliance Charitable Foundation (WS630A).