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Echinocandin Antifungal — Invasive Candidiasis / Candidaemia Pregnancy: Avoid — animal studies show teratogenicity; limited human data

Anidulafungin

Brand names: Ecalta

Adult dose

Dose: Loading: 200 mg IV on day 1; Maintenance: 100 mg IV once daily
Route: Intravenous infusion at max 1.1 mg/min
Frequency: Once daily (after loading dose)
Max: 200 mg loading; 100 mg/day maintenance
Echinocandin — inhibits beta-1,3-D-glucan synthase (fungal cell wall synthesis); fungicidal against Candida, fungistatic against Aspergillus. Not absorbed orally — IV only. No significant drug interactions (not metabolised by CYP450 — unique among antifungals). No dose adjustment for renal or hepatic impairment. Preferred over azoles for invasive candidiasis in critically ill or azole-exposed patients.

Paediatric dose

Dose: 3 mg/kg loading (max 200 mg), then 1.5 mg/kg daily (max 100 mg) mg/kg
Route: IV
Frequency: Once daily
Max: 100 mg/day
BNFc: not licensed in children <18 years — specialist use; caspofungin preferred echinocandin in paediatrics (licensed)

Dose adjustments

Renal

No dose adjustment required — not renally cleared

Hepatic

No dose adjustment required — not hepatically metabolised by CYP450; undergoes slow chemical degradation

Paediatric weight-based calculator

BNFc: not licensed in children <18 years — specialist use; caspofungin preferred echinocandin in paediatrics (licensed)

Clinical pearls

  • Key advantage over azoles: no CYP450 drug interactions — critically important in transplant patients on ciclosporin, tacrolimus, sirolimus where azoles cause significant immunosuppressant level rises
  • SCOPE EVIDENCE: ASPECT-cSSSI and invasive candidiasis trials showed non-inferiority to fluconazole; ESCMID/IDSA guidelines recommend echinocandins as first-line for invasive candidiasis in non-neutropenic patients
  • Active against azole-resistant Candida (C. krusei — intrinsically resistant to fluconazole; C. glabrata — reduced azole susceptibility): echinocandin is first-line for these species
  • C. auris (emerging MDR Candida): often echinocandin-susceptible — treatment of choice while sensitivities pending
  • Step-down to oral fluconazole once clinically stable and species confirmed sensitive — typically after 5–7 days IV

Contraindications

  • Hypersensitivity to anidulafungin or other echinocandins

Side effects

  • Infusion reactions (histamine-mediated — flushing, rash, urticaria — reduce infusion rate)
  • Elevated LFTs
  • Hypokalaemia
  • Nausea
  • Diarrhoea
  • Headache

Interactions

  • Minimal — no CYP450 interactions (major clinical advantage vs azoles)
  • Ciclosporin — mild increase in anidulafungin AUC (no dose adjustment required)

Monitoring

  • LFTs
  • Renal function and electrolytes (hypokalaemia)
  • Clinical response (serial cultures — target negative blood cultures)
  • Infusion-related reactions

Reference: BNFc; BNF 90; ESCMID Candida Guidelines 2012 (update 2020); IDSA Candidiasis Guidelines 2016; ASPECT-cSSSI Trial. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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