Echinocandin Antifungal

Anidulafungin

Brand names: Ecalta

Adult dose

Dose: Loading dose: 200 mg IV on day 1; maintenance: 100 mg IV once daily

Route: Intravenous infusion

Frequency: Once daily (after loading dose)

Clinical pearls

Echinocandin (1,3-beta-glucan synthase inhibitor) — active against most Candida species including azole-resistant strains
IDSA guidelines: echinocandins preferred for candidaemia in non-neutropenic patients and most invasive candidiasis
Not active against Cryptococcus, Mucor, or dermatophytes
Step-down to fluconazole oral usually possible after clinical improvement and if Candida species fluconazole-sensitive
Infusion reactions are concentration-dependent — do not exceed 1.1 mg/min infusion rate
Unlike azoles: no CYP450 drug interactions — advantageous in patients on multiple medications
Cross-class resistance to echinocandins (FKS mutations) is emerging — check susceptibilities

Contraindications

Hypersensitivity to anidulafungin, other echinocandins, or excipients (contains polysorbate 80)

Side effects

Infusion-related reactions (histamine-mediated: flushing, urticaria, pruritus — related to infusion rate)
Elevated liver enzymes (hepatotoxicity)
Hypokalaemia
Nausea
Hypomagnesaemia

Interactions

No significant CYP450 interactions (unlike azole antifungals)
Cyclosporin — may slightly increase anidulafungin AUC (not clinically significant)

Monitoring

LFTs (baseline and weekly)
Serum electrolytes (K⁺, Mg²⁺)
Clinical response (blood cultures until negative, then clinical and imaging)
Infusion rate and vital signs during administration

Reference: BNF; IDSA Invasive Candidiasis Guidelines (2016 updated); ESCMID Candida Guidelines (2012); NICE TA540 (echinocandins); https://bnf.nice.org.uk/drugs/anidulafungin/. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Drugs

Pathways