Anidulafungin: a new echinocandin for candidal infections

Anidulafungin, a new echinocandin, has recently been approved for the treatment of esophageal candidiasis, candidemia and other forms of invasive candidiasis, such as peritonitis and intra-abdominal abscesses in non-neutropenic patients. It is fungicidal against Candida spp. including those that are azole- and polyene-resistant and fungistatic against Aspergillus spp. Owing to its poor oral bioavailability it can only be administered intravenously. Its pharmacokinetics allow for once-daily dosing and a steady state concentration is easily achieved on day 2 following a loading dose of double the maintenance dose on day 1. It does not need adjustment for hepatic or renal insufficiency; there are no known drug interactions and it has a favorable tolerability profile. Its mechanism of action, which differs from other classes of antifungals, should prevent cross-resistance with azoles and polyenes.