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Le Infezioni in Medicina Jun 2014Invasive infections by Candida spp. play a major role in the management of the critically ill patient. Rates of positive blood cultures for Candida species have risen... (Review)
Review
Invasive infections by Candida spp. play a major role in the management of the critically ill patient. Rates of positive blood cultures for Candida species have risen fivefold in the past ten years, placing this pathogen between the fourth and the sixth-leading cause of nosocomial bloodstream infections in the United States and Europe. Candida albicans is still the cause of approximately 50% of invasive candidiasis, with heterogeneous epidemiology. The echinocandin class, along with voriconazole and liposomal amphotericin B, was recommended by 2009 IDSA guidelines with AI evidence for the treatment of candidaemia, reserving the use of fluconazole in selected situations. Conversely fluconazole was downgraded to CI recommendation (marginal use), with BI evidence for voriconazole and liposomal amphotericin B, maintaining AI (strong support) for echinocandins by 2012 ESCMID guidelines for the diagnosis and management of Candida disease in non-neutropenic adult patients. Our brief analysis of randomized trials, whereby recommendations are supported, aims to discuss the possible reasons for the different consideration of fluconazole by the two above mentioned guidelines.
Topics: Anidulafungin; Antifungal Agents; Candida; Candidiasis; Cross Infection; Echinocandins; Europe; Fluconazole; Guidelines as Topic; Humans; Italy; Randomized Controlled Trials as Topic; Treatment Outcome; United States
PubMed: 24955796
DOI: No ID Found -
Future Microbiology Dec 2008A third echinocandin, anidulafungin, has recently been approved for Candida infections in the non-neutropenic patient. In the EU it is indicated for invasive... (Review)
Review
A third echinocandin, anidulafungin, has recently been approved for Candida infections in the non-neutropenic patient. In the EU it is indicated for invasive candidiasis; in 2006 it was approved in the USA for candida esophagitis, candidemia, and two types of invasive infections, peritonitis and intra-abdominal abscesses. It is fungicidal against Candida species and fungistatic against Aspergillus species. In addition to its favorable tolerability in studies to date, it does not need adjustment for renal or hepatic insufficiency and has no known drug interactions. A steady state concentration can be achieved on day 2 following a loading dose of twice the maintenance concentration on day 1, and the drug is administered intravenously once daily. Cross resistance with other classes of antifungals is not a concern as it possesses a unique mechanism of action.
Topics: Anidulafungin; Antifungal Agents; Aspergillus; Candida; Candidiasis; Drug Resistance, Fungal; Echinocandins; Humans; Injections, Intravenous; Microbial Viability; United States
PubMed: 19072176
DOI: 10.2217/17460913.3.6.593 -
International Journal of Antimicrobial... Nov 2008Echinocandins have emerged as important agents for the treatment of invasive candidiasis. Forthcoming guidelines are expected to recommend an echinocandin agent as... (Review)
Review
Echinocandins have emerged as important agents for the treatment of invasive candidiasis. Forthcoming guidelines are expected to recommend an echinocandin agent as initial primary therapy in patients who are severely ill and/or have risk factors for azole resistance. Amphotericin B deoxycholate and fluconazole should be considered for initial therapy in specific populations. The echinocandin, anidulafungin, has been shown to have higher response rates compared with fluconazole in patients with invasive candidiasis. Additionally, patients treated with anidulafungin compared with patients receiving fluconazole have exhibited a trend toward improved survival. The three echinocandins (anidulafungin, caspofungin and micafungin) offer proven efficacy along with excellent side-effect profiles. While these three drugs have important differences, the empirical selection of an echinocandin should be based on the specific patient population, including clinical status, the suspected pathogen, and the susceptibility pattern at the institution. Once the Candida species is identified and its susceptibility is determined, clinicians should consider step-down therapy to either fluconazole or voriconazole, with possible conversion from intravenous to oral therapy.
Topics: Anidulafungin; Antifungal Agents; Candida; Candidiasis; Echinocandins; Fluconazole; Humans; Pyrimidines; Triazoles; Voriconazole
PubMed: 19013348
DOI: 10.1016/S0924-8579(08)70008-6 -
Expert Review of Anti-infective Therapy Mar 2011Cases of invasive fungal infections are increasing globally due to an increase in the immunosuppressed population, the use of broad-spectrum antibiotics and the invasive... (Review)
Review
Cases of invasive fungal infections are increasing globally due to an increase in the immunosuppressed population, the use of broad-spectrum antibiotics and the invasive instrumentation of patients in intensive care units. Ongoing emergence of resistance and problems with toxicity have resulted in the need for the development of new antifungal agents. Anidulafungin, the most recently developed echinocandin, is approved by the US FDA for treatment of candidemia, other forms of Candida infection and esophageal candidiasis in non-neutropenic adult patients, but it is not currently licensed for pediatric usage. The drug is projected to be distinctive owing to its unique pharmacokinetics and is already listed in adult antifungal treatment guidelines. In this article, anidulafungin will be reviewed with a focus on pediatric patients.
Topics: Adult; Anidulafungin; Antifungal Agents; Aspergillosis; Aspergillus; Candida; Candidiasis, Invasive; Child; Drug Interactions; Drug Resistance, Fungal; Drug Therapy, Combination; Echinocandins; Humans
PubMed: 21417873
DOI: 10.1586/eri.11.7 -
Antimicrobial Agents and Chemotherapy Nov 2023Echinocandins like anidulafungin are first-line therapies for candidemia and invasive candidiasis, but their dosing may be suboptimal in obese patients. Our objective...
Echinocandins like anidulafungin are first-line therapies for candidemia and invasive candidiasis, but their dosing may be suboptimal in obese patients. Our objective was to quantify anidulafungin exposure in a cohort of adults across a wide body size range to test if body size affects anidulafungin pharmacokinetics (PK). We enrolled 20 adults between the ages of 18 and 80 years, with an equal distribution of patients above and below a body mass index of 30 kg/m. A single 100-mg dose of anidulafungin was administered, followed by intensive sampling over 72 h. Population PK analysis was used to identify and compare covariates of anidulafungin PK parameters. Monte Carlo simulations were performed to compute the probability of target attainment (PTA) based on alternative dosing regimens. Participants (45% males) had a median (range) age of 45 (21-78) years and a median (range) weight of 82.7 (42.4-208.3) kg. The observed median (range) of AUC was 106.4 (51.9, 138.4) mg∙h/L. Lean body weight (LBW) and adjusted body weight (AdjBW) were more influential than weight as covariates of anidulafungin PK parameters. The conventional 100 mg daily maintenance is predicted to have a PTA below 90% in adults with an LBW > 55 kg or an AdjBW > 75 kg. A daily maintenance dose of 150-200 mg is predicted in these heavier adults. Anidulafungin AUC declines with increasing body size. A higher maintenance dose will increase the PTA compared to the current approach in obese patients.
Topics: Adult; Male; Humans; Adolescent; Young Adult; Middle Aged; Aged; Aged, 80 and over; Female; Anidulafungin; Antifungal Agents; Obesity; Body Weight; Candidiasis, Invasive; Body Size; Monte Carlo Method
PubMed: 37850741
DOI: 10.1128/aac.00820-23 -
Mycoses 2007Anidulafungin is the most recent development in the echinocandin class antifungals. Like other echinocandins, it inhibits 1,3-beta-d-glucan synthesis, thus achieving... (Review)
Review
Anidulafungin is the most recent development in the echinocandin class antifungals. Like other echinocandins, it inhibits 1,3-beta-d-glucan synthesis, thus achieving fungicidal activity against many Candida spp. including those resistant to fluconazole as well as fungistatic activity against some clinically important filamentous fungi, especially Aspergillus spp. The drug is well tolerated, even in patients with renal or hepatic impairment. It has a low drug-drug interaction profile as it does not significantly interfere with the cytochrome P450 pathway. Anidulafungin has been approved for treatment of candidaemia, intra-abdominal abscesses, peritonitis and oesophageal candidiasis. Trials have shown non-inferiority of anidulafungin to fluconazole in the treatment of invasive and non-invasive candidiasis. After promising results from animal models, the role of anidulafungin in the treatment of invasive aspergillosis and other filamentous fungi is yet to be cleared. Currently, anidulafungin offers another alternative in the treatment of Candida infections, especially in patients where avoidance of drug-drug interactions is needed. Future investigations may elucidate how anidulafungin performs clinically in comparison with the other echinocandins.
Topics: Anidulafungin; Animals; Antifungal Agents; Aspergillosis; Candidiasis; Disease Models, Animal; Drug Interactions; Echinocandins; Humans; Rabbits
PubMed: 17394608
DOI: 10.1111/j.1439-0507.2007.01378.x -
Expert Opinion on Drug Safety Nov 2006The echinocandins are a new class of antifungal that have shown promising results in treating a variety of fungal infections. Anidulafungin is the newest approved... (Review)
Review
The echinocandins are a new class of antifungal that have shown promising results in treating a variety of fungal infections. Anidulafungin is the newest approved echinocandin and may have some advantages over existing antifungals. It has activity against a broad range of fungi. It is unique because it undergoes a process of slow chemical degradation rather than being metabolised. Studies evaluating the use of anidulafungin in combination with other commonly used drugs have not demonstrated any significant drug-drug interactions or adverse events. Thus far, anidulafungin appears to have an excellent safety profile with few adverse events. Based on early clinical experience, it appears that anidulafungin will be a valuable and safe asset in the management of serious and difficult-to-treat fungal infections.
Topics: Anidulafungin; Animals; Antifungal Agents; Echinocandins; Humans; Peptides, Cyclic
PubMed: 17044802
DOI: 10.1517/14740338.5.6.751 -
Drugs of Today (Barcelona, Spain : 1998) Aug 2006Immunocompromised hosts are at increased risk for invasive fungal infections. Over the last five decades, the mainstay of therapy against systemic mycoses has revolved... (Review)
Review
Immunocompromised hosts are at increased risk for invasive fungal infections. Over the last five decades, the mainstay of therapy against systemic mycoses has revolved around amphotericin B deoxycholate. Unfortunately, this drug has substantial toxicities, and agents such as fluconazole were developed as an alternative to treat and prevent these invasive infections. Due to widespread use, fluconazole-resistant organisms have emerged; therefore, new agents with improved safety, efficacy and tolerability have now become desirable. The echinocandins are a new class of antifungal agents with novel activity against the fungal cell wall. In February 2006, the U.S. Food and Drug Administration approved the echinocandin anidulafungin for the treatment of patients with candidemia, peritonitis, intra-abdominal abscesses and esophageal candidiasis.
Topics: Anidulafungin; Animals; Antifungal Agents; Drug Interactions; Echinocandins; Humans; Mycoses; Peptides, Cyclic; Randomized Controlled Trials as Topic
PubMed: 16969430
DOI: 10.1358/dot.2006.42.8.996569 -
Antimicrobial Agents and Chemotherapy Jun 2021Concentrations of anidulafungin and micafungin were determined in eight different tissues obtained during autopsy of four deceased individuals who had been treated with...
Concentrations of anidulafungin and micafungin were determined in eight different tissues obtained during autopsy of four deceased individuals who had been treated with anidulafungin and of seven who had received micafungin. The largest amounts were recovered from liver, with anidulafungin concentrations of 11.01 to 66.50 μg/g and micafungin levels of 0.36 to 5.53 μg/g (0.65 μg/g 30 days after the last administration). The lowest anidulafungin levels were measured in skeletal muscle, and the lowest micafungin concentrations were in kidneys.
Topics: Anidulafungin; Antifungal Agents; Echinocandins; Humans; Lipopeptides; Micafungin; Tissue Distribution
PubMed: 33875434
DOI: 10.1128/AAC.00169-21 -
IDrugs : the Investigational Drugs... Oct 2003Anidulafungin, a 1,3-beta-glucan synthesis inhibitor and the pentyloxyterphenyl side chain derivative of echinocandin B, is being developed by Vicuron Pharmaceuticals... (Review)
Review
Anidulafungin, a 1,3-beta-glucan synthesis inhibitor and the pentyloxyterphenyl side chain derivative of echinocandin B, is being developed by Vicuron Pharmaceuticals Inc, under license from Eli Lilly & Co, for the potential treatment of fungal infection.
Topics: Anidulafungin; Animals; Antifungal Agents; Clinical Trials as Topic; Drugs, Investigational; Echinocandins; Humans; Peptides, Cyclic
PubMed: 14534856
DOI: No ID Found