Anidulafungin for the treatment of invasive candidiasis

Abstract

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.

Anidulafungin for the treatment of candidaemia/invasive candidiasis in selected critically ill patients

“…Also noteworthy is that anidulafungin was just as effective against C. parapsilosis as against other species. This particular pathogen has somewhat higher echinocandin minimum inhibitory concentrations (MICs) than other Candida species, although the clinical significance of these findings is unknown [9,26,27]. The treatment response for C. tropicalis was lower than for other Candida species and also lower than reported previously with anidulafungin for C. tropicalis [13].…”

Early Empirical Anidulafungin Reduces the Prevalence of Invasive Candidiasis in Critically Ill Patients: A Case-control Study

“…Animal studies and In vitro data demonstrate that anidulafungin is active against C. albicans and C. parapsilosis biofilms [ 47 ], and exhibits post‐antifungal effect (PAFE) (i.e. ongoing antifungal activity at limited exposure to an antifungal) like other members of echinocandins class [ 48 ]. An in vitro study reported that anidulafungin possesses PAFE for a longer period even at concentrations below its minimum inhibitory concentration (MIC) compared with fluconazole, caspofungin and amphotericin B, and in contrast, fluconazole has no PAFE effect at any of its concentration, caspofungin has a shorter PAFE period (0-2 h) and amphotericin B also exhibits a shorter duration of PAFE at levels below the MIC [ 49 ].…”

PET/CT Imaging for Personalized Management of Infectious Diseases

“…Quantitative FDG-PET/CT follow up is already performed in oncologic diseases such as lymphoma and melanoma to monitor treatment response, but may also be beneficial in patients with chronic infection and long-term antimicrobial treatment [ 78 ]. Additionally, (follow up) PET/CT may also aid physicians in deciding to switch from intravenous to oral antibiotic treatment, or from more expensive antifungals such as anidulafungin to the cheaper but maybe less effective fluconazole [ 79 ].…”