Anidulafungin compared with fluconazole therapy in critically ill patients

Kett, DH; Shorr, AF; Reboli, AC; Reisman, AC; Biswas, Pinaki; Schlamm, H. T.

doi:10.1186/cc8304

Cited by 5 publications

(10 citation statements)

References 1 publication

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“…Across groups, no significant survival advantages at either day 14 or day 28 were observed. The investigators concluded that anidulafungin was significantly more effective than fluconazole for the treatment of candidaemia in critically ill patients (defined as either those with sepsis and multiple organ dysfunction or those with APACHE II scores ‡15) [90]. This observation lends support to current guidelines [4,7,42] recommending echinocandins as first-line C/IC treatment in this population [90].…”

Section: Clinical Efficacy and Safetymentioning

confidence: 80%

“…Critically ill patients comprise another important patient subgroup, and a post hoc analysis was therefore conducted to compare the responses to anidulafungin and fluconazole in this population [90]. For the purposes of that analysis, three groups of critically ill patients were identified from the original trial [62]: those in the ICU at study entry ( n = 89); patients with APACHE II scores ≥15 ( n = 113); and patients with severe sepsis and organ dysfunction ( n = 118) [90]. Global responses at EOIT were better with anidulafungin in each of these subgroups, but the difference only reached statistical significance in the second group.…”

Section: Clinical Efficacy and Safetymentioning

confidence: 99%

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Anidulafungin for the treatment of invasive candidiasis

Mayr

Aigner

Lass‐Flörl

2011

Clinical Microbiology and Infection

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Candidaemia/invasive candidiasis (C/IC) is the most frequently occurring invasive fungal infection worldwide, with a particularly strong impact and high incidence in the intensive-care unit, where there is a need for new treatment options and strategies. The echinocandin anidulafungin has broad in vitro activity against a wide range of Candida species, along with favourable pharmacokinetics that allow administration in hepatic and renal impairment and with any comedication without the need for dose adjustments. The efficacy and safety of anidulafungin for the treatment of C/IC were demonstrated in a number of clinical studies and by some limited data from clinical practice. In a randomized comparative trial for the treatment of C/IC in adults, 76% of patients receiving anidulafungin and 60% of those given fluconazole were treated successfully (95% CI for difference: 4-27; p 0.01). Post hoc analyses suggest that anidulafungin is significantly more effective than standard-dose fluconazole for the treatment of candidaemia in critically ill patients. Anidulafungin is generally well tolerated, with commonly reported side effects including headache, hypokalaemia, gastrointestinal symptoms, abnormal liver function test results, and rash. In pharmaco-economic analyses, anidulafungin compared favourably with fluconazole (in terms of overall costs and hospital resource use) as well as with other echinocandins. Echinocandins, including anidulafungin, are now generally recommended as first-line therapy in moderately to severely ill patients, those with prior azole exposure, and patients with C/IC caused by Candida glabrata or Candida krusei.

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Section: Clinical Efficacy and Safetymentioning

confidence: 80%

Section: Clinical Efficacy and Safetymentioning

confidence: 99%

Anidulafungin for the treatment of invasive candidiasis

Mayr

Aigner

Lass‐Flörl

2011

Clinical Microbiology and Infection

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“…In subgroup analyses, patients with organ dysfunction (lung, kidney, liver or cardiovascular) had consistently higher global success rates in the anidulafungin group 20 . The difference was significant for patients with APACHE II scores >15 and those with severe sepsis and multiorgan dysfunction 20 …”

Section: Factors Determining the Initial Choice Of Therapymentioning

confidence: 93%

“…19 In subgroup analyses, patients with organ dysfunction (lung, kidney, liver or cardiovascular) had consistently higher global success rates in the anidulafungin group. 20 The difference was significant for patients with APACHE II scores >15 and those with severe sepsis and multiorgan dysfunction. 20 On the basis of the results of this study 19 -and the cumulative experience with this class of antifungalsthe EFISG panel chose to recommend echinocandins as the class of choice (recommendation grade A; evidence grade I) for primary targeted therapy of candidaemia in all patients.…”

Section: Severity Of Illnessmentioning

confidence: 95%

“…A randomised study comparing anidulafungin vs. fluconazole for candidaemia showed a significantly higher global success rate in the total population for the echinocandin 19 . In subgroup analyses, patients with organ dysfunction (lung, kidney, liver or cardiovascular) had consistently higher global success rates in the anidulafungin group 20 . The difference was significant for patients with APACHE II scores >15 and those with severe sepsis and multiorgan dysfunction 20 …”

Section: Factors Determining the Initial Choice Of Therapymentioning

confidence: 99%

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Practical considerations on current guidelines for the management of non‐neutropenic adult patients with candidaemia

Glöckner

Cornely

2012

Mycoses

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Recent guideline recommendations on the management of candidaemia provide valuable treatment guidance for routine clinical practice, but need to be interpreted in the light of the actual situation of the patient and the local epidemiology of fungal infections. Echinocandins emerge as the generally preferred primary treatment. Treatment should be initiated immediately after notification of a Candida-positive blood culture in all patients. Ambiguous issues include the definition of optimum duration of treatment, the indication and time point to step down to oral azoles, catheter management, and the appropriate approach in critically ill patients at high risk for candidaemia in the absence of definitive proof of infection. Patients with clinical suspicion of antifungal treatment failure need prompt workup for adequacy of treatment, focal sources of sustained infection and potential superinfection.

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