What is the recommended dose of Anidulafungin (Echinocandin) for treating candidemia and invasive candidiasis?

From the Guidelines

The recommended dose of anidulafungin for treating candidemia and invasive candidiasis in adults is a 200 mg loading dose on day 1, followed by 100 mg daily thereafter. This recommendation is based on the most recent and highest quality study available, which is the 2016 update by the Infectious Diseases Society of America 1. The medication should be administered intravenously, typically infused over 1.5 to 3 hours.

Key Points to Consider

• Treatment should continue for at least 14 days after the last positive blood culture and resolution of clinical symptoms.
• For patients with neutropenia, therapy should be continued throughout the neutropenic period.
• Anidulafungin does not require dose adjustment for renal or hepatic impairment, which is an advantage over some other antifungals.
• The drug works by inhibiting 1,3-β-D-glucan synthase, an enzyme necessary for fungal cell wall synthesis, leading to cell lysis and death of susceptible Candida species.
• Anidulafungin has activity against most Candida species, including those resistant to fluconazole.
• Monitoring for adverse effects is important, with the most common being histamine-mediated reactions during infusion such as rash, urticaria, flushing, pruritus, dyspnea, and hypotension.

Additional Considerations

• The choice of anidulafungin as initial therapy is recommended for patients with moderately severe to severe illness or for patients who have had recent azole exposure 1.
• For infections due to C. krusei, an echinocandin, lipid formulation AmB, or voriconazole is recommended 1.
• The recommended minimum duration of therapy for candidemia without metastatic complications is 2 weeks after documented clearance of Candida from the bloodstream, provided neutropenia and symptoms attributable to candidemia have resolved 1.

From the FDA Drug Label

The maximum non-lethal dose of anidulafungin in rats was 50 mg/kg, a dose which is equivalent to 10 times the recommended daily dose for esophageal candidiasis (50 mg/day) or equivalent to 5 times the recommended daily dose for candidemia and other Candida infections (100 mg/day), based on relative body surface area comparisons

The recommended dose of Anidulafungin for treating candidemia and invasive candidiasis is 100 mg/day 2.

• The dose is administered as a single loading dose of 200 mg on the first day, followed by a maintenance dose of 100 mg daily.
• No dosage adjustments are required for patients with any degree of hepatic or renal insufficiency.

From the Research

Anidulafungin Dose for Treating Candidemia and Invasive Candidiasis

• The recommended dose of Anidulafungin for treating candidemia and invasive candidiasis is as follows:
  • A loading dose of 200 mg on day 1, followed by a maintenance dose of 100 mg daily 3
• This dosing regimen is supported by clinical trials that demonstrated the efficacy and safety of anidulafungin in treating invasive candidiasis 4, 5
• The dose of anidulafungin does not require adjustment in patients with hepatic or renal impairment, and it can be administered with other medications without significant drug interactions 4, 6
• Clinical trials have shown that anidulafungin is effective in treating candidemia and invasive candidiasis, with success rates ranging from 72% to 90% 5
• Anidulafungin has been compared to fluconazole in clinical trials, and it has been shown to be more effective in treating candidemia in critically ill patients 4, 3
• The use of anidulafungin as first-line therapy for invasive candidiasis is supported by recent guideline recommendations and treatment optimization strategies 7