title: A Comparative Study of the Effects of Intravitreal Anidulafungin, Voriconazole, and Amphotericin B in an Experimental Candida Endophthalmitis Model.
abstract: To compare the safety and efficacy of intravitreal anidulafungin injection with voriconazole and amphotericin B (Amp B) in an experimental Candida endophthalmitis (CE) model.
  
  
  
  Intravitreal 1 × 105CFU/0.1 ml Candida albicans was injected into the right eyes of 24 New Zealand rabbits, which were divided into 4 groups. Voriconazole 50 μg/0.1 ml, Amp B 10 μg/0.1 ml, and Anidulafungin 50 μg/0.1 ml were injected by intravitreal injection 72 h after inoculation. The control group was injected with 0.1 ml 0.9% NaCl. Clinical scoring was performed by assessing the cornea, conjunctiva, iris, and vitreous on days 3 and 7 of therapy. At the end of the study, the right eyes of all rabbits were enucleated and histopathological evaluation was performed. Therapy groups were compared according to the clinical, histopathological, and microbiological analysis scores.
  
  
  
  Total clinical scores were significantly different between treatment groups and the control group (p < 0.05). On day 7 of the therapy, clinical scores of the anidulafungin group were found to be significantly lower when compared with the other therapy groups, while a significant improvement was observed in the eyes of rabbits in the anidulafungin group (p < 0.05). Also, microbiological scores of the anidulafungin group were lower than those of the control group (p < 0.05). Histopathological scores of the anidulafungin treatment group were significantly better than the voriconazole and control groups. Inflammation was evidently suppressed and marked retinal toxicity was not observed with anidulafungin.
  
  
  
  This is the first study comparing the efficacy of anidulafungin with other antifungal agents. In this CE model, an intravitreal single dose of anidulafungin was shown to be noninferior to voriconazole and Amp B. As an alternative to Amp B or voriconazole, intravitreal anidulafungin is suggested as an effective antifungal agent for the treatment of CE.
authors.affiliation: a Department of Infectious Diseases and Clinical Microbiology , GATA Haydarpasa Training Hospital , Istanbul , Turkey.
authors.forename: Ergenekon
authors.initials: E
authors.lastname: Karagoz
authors.affiliation: b Department of Pharmacology, Faculty of Pharmacy , Atatürk University , Erzurum , Turkey.
authors.forename: Rustem Anil
authors.initials: RA
authors.lastname: Ugan
authors.affiliation: c Department of Ophthalmology , GATA Haydarpasa Training Hospital , Istanbul , Turkey.
authors.forename: Eyup
authors.initials: E
authors.lastname: Duzgun
authors.affiliation: b Department of Pharmacology, Faculty of Pharmacy , Atatürk University , Erzurum , Turkey.
authors.forename: Elif
authors.initials: E
authors.lastname: Cadirci
authors.affiliation: d Department of Ophthalmology, Medical Faculty , Atatürk University , Erzurum , Turkey.
authors.forename: Sadullah
authors.initials: S
authors.lastname: Keles
authors.affiliation: e Department of Medical Microbiology, Medical Faculty , Atatürk University , Erzurum , Turkey.
authors.forename: M Hamidullah
authors.initials: MH
authors.lastname: Uyanik
authors.affiliation: f Department of Pathology , Gulhane Military Medical Academy , Ankara , Turkey.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Yavan
authors.affiliation: a Department of Infectious Diseases and Clinical Microbiology , GATA Haydarpasa Training Hospital , Istanbul , Turkey.
authors.forename: Vedat
authors.initials: V
authors.lastname: Turhan
mesh_terms: D000666:Amphotericin B / Q000008:administration & dosage*; D000077612:Anidulafungin; D000818:Animals; D000935:Antifungal Agents / Q000008:administration & dosage; D002176:Candida albicans / Q000302:isolation & purification; D002177:Candidiasis / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D003228:Conjunctiva / Q000382:microbiology / Q000473:pathology; D004195:Disease Models, Animal; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D054714:Echinocandins / Q000008:administration & dosage*; D009877:Endophthalmitis / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D015821:Eye Infections, Fungal / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D058449:Intravitreal Injections; D007498:Iris / Q000382:microbiology / Q000473:pathology; D008297:Male; D011817:Rabbits; D014822:Vitreous Body / Q000382:microbiology / Q000473:pathology; D065819:Voriconazole / Q000008:administration & dosage*
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D000666:Amphotericin B; D000077612:Anidulafungin; D065819:Voriconazole
keywords: Amphotericin B; Anidulafungin; Candida endophthalmitis; voriconazole