Anidulafungin, a new echinocandin: effectiveness and tolerability

Anidulafungin is a new echinocandin with potent in vitro activity against Aspergillus and Candida species, including those resistant to fluconazole and amphotericin B. Results of several clinical trials indicate that anidulafungin is effective in treating oesophageal candidiasis, including azole-refractory disease. The results of a single randomized clinical trial comparing fluconazole and anidulafungin demonstrated that anidulafungin was noninferior to fluconazole in the treatment of candidaemia and invasive candidiasis. Studies evaluating the concomitant use of anidulafungin and either amphotericin B, voriconazole or ciclosporin did not demonstrate significant drug-drug interactions or adverse events. Anidulafungin appears to have an excellent safety profile: alterations of liver enzymes have been reported and slow infusion is recommended to prevent histamine-like reactions. On the basis of early clinical experience, it appears that anidulafungin will be a valuable option in the management of serious and difficult-to-treat fungal infections.