Anidulafungin--state of affairs from a clinical perspective

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.