Anidulafungin and its role in candida infections

Abstract

Candida infections continue to play a significant role not only in critically ill and immunocompromised patients but also in non-compromised patients. The incidence of systemic fungal infections in the United States has been on the rise for the past 30 years. Anidulafungin and all echinocandins inhibit glucan synthase thus inhibiting the formation of 1,3-β-D-glucan which is an essential component of the fungal cell wall. The decrease in 1,3-β-D-glucan results in the osmotic lysis of the cell, resulting in fungicidal activity against candida. Anidulafungin is active against most species of candida and resistance to it is very rare. Two potential mechanisms conferring reduced susceptibility to the echinocandins are efflux and target alteration. The efflux pump associated with fluconazole resistance in Candida albicans can confer higher minimum inhibitory concentrations to caspofungin. The second mechanism of resistance is via mutations in the genes which code for 1,3 β-D-glucan synthase, specifically FKS1. Because of its spectrum of activity, fungicidal nature, and tolerability it is an attractive first-line therapeutic choice for treating candidemia in both non-neutropenic and neutropenic patients. Because it is available only parenterally its role in treating mucocutaneous candidiasis is primarily in patients unable to take oral therapy.

A severe case of haemodynamic instability during anidulafungin administration

“…[1][2][3] This relatively new class of antifungals is characterized by a low probability of drugdrug interactions. 4 Echinocandins are usually well tolerated, nevertheless rare adverse events can occur.…”

“…With rising incidence of fungal infections, echinocandins have become important in the treatment of invasive Candidiasis and are recommended for initial targeted therapy. [1][2][3] This relatively new class of antifungals is characterized by a low probability of drugdrug interactions. 4 Echinocandins are usually well tolerated, nevertheless rare adverse events can occur.…”

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

“…Candida UTI and candidemia are also frequent in ICU patients with high rate of mortality and morbidity [ 1 , 5 ]. Candidemia is accountable for 5.6 to 10% of nosocomial bloodstream infections [ 55 , 56 , 57 ], and studies found that anidulafungin exhibits superior clinical outcomes than fluconazole in the treatment of bloodstream infections caused by Candida strains susceptible or resistant to fluconazole [ 33 , 58 , 59 ]. In this study, Candida pneumonia was relatively higher than Candida UTI and candidemia in both groups, and patients of NEAT group demonstrated higher rate of CP (22.2%) than the patients of EAT group (3.8%).…”

“…For a confirmatory diagnosis of an invasive fungal infection without distinguishable signs and symptoms in the critically ill patients during the early hours of ICU admission is still a complicated issue for the clinicians worldwide [ 22 ]. Initiation of IC treatment based on microbial culture report is a time consumable basis of treatment, and in some cases, clinical conditions of patients are extremely deteriorated before getting the culture report in hand [ 58 ]. Study found that approximately 40%-50% of patients are admitted in ICU with candidemia and its diagnosis takes days to confirm [ 2 , 61 ].…”