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Logo of ccforumBioMed CentralBiomed Central Web Sitesearchsubmit a manuscriptregisterthis articleCritical CareJournal Front Page
Crit Care. 2010; 14(Suppl 1): P72.
Published online 2010 March 1. doi:  10.1186/cc8304
PMCID: PMC2933999

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 Figure11.

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.


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