title: Early clinical experience with anidulafungin at a large tertiary care medical center.
abstract: OBJECTIVE
  To evaluate early clinical experience with anidulafungin.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Large, university-affiliated, tertiary care medical center.
  
  
  METHODS
  All patients receiving anidulafungin between July 15, 2006, and January 15, 2007.
  
  
  RESULTS
  Thirty-five patients received at least one dose of anidulafungin. Safety and tolerability were evaluated in all patients; efficacy outcomes were assessed in 13 patients who had a documented fungal infection and received anidulafungin for a minimum of 5 days. Common conditions at baseline were hepatic dysfunction (25 patients [71%]), severe sepsis (17 patients [49%]), and solid organ or hematopoietic stem cell transplantation (10 patients [29%]). Eight patients (23%) were receiving drugs with the potential to interact with echinocandins other than anidulafungin. Seventeen (49%) of the 35 patients received anidulafungin as empiric antifungal therapy. Anidulafungin was used to treat invasive candidiasis in seven patients (20%) and candidemia in 10 patients (29%); Candida albicans or Candida glabrata was isolated most frequently in these two infections combined (7 isolates each [41%]/17 infections). A favorable efficacy outcome was noted in 10 (77%) of 13 evaluable patients. One patient developed breakthrough Candida parapsilosis fungemia while receiving anidulafungin. Overall, anidulafungin was well tolerated, with only one patient having an infusion- related reaction. Anidulafungin was also well tolerated among patients receiving concomitant metronidazole.
  
  
  CONCLUSIONS
  Anidulafungin was well tolerated and produced favorable outcomes in the majority of the patients evaluated. The availability of anidulafungin makes it a feasible option for antifungal therapy, particularly in patients who have hepatic dysfunction and in those who are receiving drugs than can interact with other echinocandins.
authors.affiliation: Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, Missouri 63110, USA.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Brielmaier
authors.forename: Ed
authors.initials: E
authors.lastname: Casabar
authors.forename: Christine M
authors.initials: CM
authors.lastname: Kurtzeborn
authors.forename: Peggy S
authors.initials: PS
authors.lastname: McKinnon
authors.forename: David J
authors.initials: DJ
authors.lastname: Ritchie
mesh_terms: D000046:Academic Medical Centers; D000410:Alanine Transaminase / Q000378:metabolism; D000077612:Anidulafungin; D000935:Antifungal Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001219:Aspartate Aminotransferases / Q000378:metabolism; D001416:Back Pain / Q000139:chemically induced; D002175:Candida / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification; D002177:Candidiasis / Q000175:diagnosis / Q000188:drug therapy; D004359:Drug Therapy, Combination; D054714:Echinocandins / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008923:Missouri; D009181:Mycoses / Q000175:diagnosis / Q000188:drug therapy*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D008795:Metronidazole; D000077612:Anidulafungin; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase