Skip to main content

Anidulafungin compared with fluconazole therapy in critically ill patients

Introduction

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].

Methods

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.

Results

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
figure1

Global response to treatment.

Conclusions

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.

References

  1. 1.

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

    PubMed  CAS  Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to DH Kett.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Kett, D., Shorr, A., Reboli, A. et al. Anidulafungin compared with fluconazole therapy in critically ill patients. Crit Care 14, P72 (2010). https://doi.org/10.1186/cc8304

Download citation

Keywords

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