More
antifungal agents have reached clinical use in the past two decades than at any other time. The
echinocandins have been a welcome addition to this group, with the latest being
anidulafungin. There are several lines of evidence to support
anidulafungin's role as primary
therapy for the treatment of
invasive candidiasis in non-neutropenic patients, and as alternative
therapy to
fluconazole in patients with esophageal
candidiasis with
azole intolerance or
triazole-resistant Candida. Pharmacokinetic-pharmacodynamic studies in animals have demonstrated superior efficacy, defined as maximal microbial kill, when compared to
fluconazole, regardless of the
fluconazole susceptibility of the Candida species. These studies, as well as dose-effect studies in patients, also support the currently recommended dose of
anidulafungin. A well designed randomized controlled trial has demonstrated
anidulafungin's efficacy in patients with
invasive candidiasis. In this paper, we argue that
anidulafungin may be preferable to
fluconazole for the treatment of
candidemia. However, as of yet, the difference between
anidulafungin and the other two licensed
echinocandins as first-line
therapy for
invasive candidiasis is unclear. On the other hand, there is insufficient evidence as of yet to support first-line use of
anidulafungin in patients with
neutropenia or
aspergillosis.