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Anidulafungin compared with fluconazole therapy in critically ill patients


The 2009 IDSA Treatment Guidelines for Candidiasis favor an echinocandin for initial treatment of candidemia in patients with severe illness. In a prospective, randomized study anidulafungin resulted in improved global response (GR) and a trend toward improved survival compared with fluconazole [1].


Retrospective analysis in patients classified as severely ill at study entry: treatment initiated in an ICU (Group 1), APACHE II score ≥15 (Group 2) or presence of severe sepsis (Group 3). Within groups, anidulafungin was compared with fluconazole for GR rate at the end of intravenous therapy and 14-day and 28-day mortality.


In Group 1 (n = 89), GR was 63.3% vs 45.0% (95% CI: -2.2 to 38.8); Group 2 (n = 113), GR was 68.3% vs 46.0% (95% CI: 4.3 to 40.2); and Group 3 (n = 118), the GR was 67.7% vs 51.8% (95% CI: -1.6 to 33.5), in patients with MOD (n = 45), the GR was 76.2% vs 29.2% (95% CI: 21.3 to 72.8) anidulafungin versus fluconazole, respectively. Across groups, an association with anidulafungin use and lower day 14 mortality was suggested (12.2% to 14.3% for patients receiving anidulafungin vs 19.6% to 28.0% for those receiving fluconazole) (P = NS). See Figure 1.

Figure 1

Global response to treatment.


In patients with severe illness, anidulafungin was associated with greater GR than fluconazole, significantly so for those with APACHE II score ≥15 or with MOD, supporting the IDSA Guidelines.


  1. 1.

    Reboli AC, et al: N Engl J Med. 2007, 356: 2472-2482. 10.1056/NEJMoa066906.

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Correspondence to DH Kett.

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Kett, D., Shorr, A., Reboli, A. et al. Anidulafungin compared with fluconazole therapy in critically ill patients. Crit Care 14, P72 (2010).

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  • Public Health
  • Emergency Medicine
  • Retrospective Analysis
  • Initial Treatment
  • Fluconazole