[Current treatment of candidemia. Role of anidulafungin].
Despite recent advances in antifungal therapy, the incidence of invasive Candida infections and resulting mortality have remained unchanged in the last few years. In surveillance studies published to date, the estimated incidence of candidemia differs depending on the geographic area and is significantly higher in North America than in Europe. The main predisposing conditions for candidemia are neutropenia, cellular immunity deficit, and alteration of normal microbial flora. Some independent risk factors have been identified, such as previous colonization, antibiotic therapy, central venous catheters, neutropenia, and renal dysfunction. In the last two decades, the proportion of infections due to non-albicans Candida has markedly increased. Although fluconazole use has been considered one of the main causes for the epidemiologic change in invasive candidiasis, especially in the increase of species less sensitive to this agent, this association remains unproven. These recent epidemiological changes are highly important when selecting treatment for candidemia. The echinocandins, which include anidulafungin, represent a step forward in the treatment of these infections. The clinical efficacy, tolerability and safety of anidulafungin have been demonstrated in controlled clinical trials in candidemia and invasive candidiasis. Current recommendations include this antifungal agent in the initial empirical therapy of certain patients, especially in those with a critical clinical situation, previous azole exposure, or the possibility of developing adverse events or drug interactions.
Almirante
Benito
B
Servicio de Enfermedades Infecciosas, Hospital Universitari Vall d'Hebron, Barcelona, España. balmirante@vhebron.net
Pemán
Javier
J
D000328:Adult; D000368:Aged; D000077612:Anidulafungin; D000935:Antifungal Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D002177:Candidiasis / Q000188:drug therapy* / Q000453:epidemiology; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data; D004198:Disease Susceptibility; D004311:Double-Blind Method; D025141:Drug Resistance, Fungal; D054714:Echinocandins / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D015725:Fluconazole / Q000627:therapeutic use; D016469:Fungemia / Q000188:drug therapy* / Q000453:epidemiology; D005767:Gastrointestinal Diseases / Q000139:chemically induced; D014943:Global Health; D006801:Humans; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009503:Neutropenia / Q000150:complications; D012307:Risk Factors; D013045:Species Specificity
D000935:Antifungal Agents; D054714:Echinocandins; D015725:Fluconazole; D000077612:Anidulafungin