Among antifungal drugs, echinocandins (micafungin, caspofungin and anidulafungin) represent a rational choice for the first-line therapy of candidemia/invasive candidiasis in critically ill patients. Among other properties characterizing echinocandins, it’s important to emphasize the broad spectrum of activity, the fungicidal activity against the majority of Candida spp., and the activity against the biofilm. Furthermore, echinocandins show greater efficacy than conventional amphotericin B and fluconazole, and similar efficacy to liposomal amphotericin B (but they are less toxic). Finally, echinocandins are recommended at the highest level of evidence (AI) for the treatment of invasive candidiasis by IDSA and ESCMID guidelines.
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