anidulafungin

Anidulafungin is an antifungal medication in the echinocandin class, administered by intravenous infusion. It is marketed under the brand name Eraxis and developed for the treatment of invasive candidiasis and esophageal candidiasis in adults and certain pediatric patients.

Mechanism of action

Anidulafungin inhibits 1,3-beta-D-glucan synthase, an enzyme essential for synthesizing 1,3-beta-D-glucan, a major component of the fungal cell wall. Inhibition weakens the cell wall, leading to lysis and death of susceptible Candida species.

Clinical use and spectrum

It has activity against most Candida species, including azole-resistant strains of Candida. Activity is reduced or variable against Candida parapsilosis. It is not active against Cryptococcus neoformans and generally has limited activity against molds such as Aspergillus species; it is not a first-line monotherapy for aspergillosis but may be used in certain invasive fungal infection scenarios.

Dosing and administration

Anidulafungin is given by IV infusion. The common adult regimen for invasive candidiasis and esophageal candidiasis is a loading dose of 200 mg on day 1, followed by 100 mg once daily. Dose adjustments for renal impairment are not required, and hepatic impairment generally does not necessitate dose changes, although data in severe hepatic disease are limited.

Safety and adverse effects

Common adverse events include nausea, fever, diarrhea, and infusion-related reactions. Elevations in liver enzymes can occur but hepatotoxicity is relatively uncommon. As with all antifungals, monitoring for hypersensitivity and liver function is prudent.

Resistance and pharmacology

Resistance can arise via mutations in the FKS1 gene affecting glucan synthase. Clinically significant resistance to echinocandins is uncommon but may occur in certain Candida species, sometimes with cross-resistance within the class. Anidulafungin is eliminated largely by non-enzymatic degradation and has minimal reliance on hepatic metabolism.