Anidulafungin

Candidemia, intra-abdominal or peritoneal candidiasis: IV: Initial dose: 200 mg on day 1; subsequent dosing: 100 mg daily; treatment should continue until 14 days after last positive culture. Note: IDSA Candidiasis guidelines recommend transition to fluconazole (eg, after 5 to 7 days in nonneutropenic patients) in clinically stable patients with fluconazole-susceptible isolates and negative repeat cultures (IDSA [Pappas 2016]) Candidiasis, chronic disseminated (hepatosplenic) (off-label use): IV: 200 mg on day 1; subsequent dosing: 100 mg daily for several weeks, followed by oral fluconazole therapy (IDSA [Pappas 2016]) Candidiasis, empiric therapy (suspected invasive candidiasis in nonneutropenic ICU patients) (off-label use): IV: 200 mg on day 1; subsequent dosing: 100 mg daily; treatment should continue for 14 days in patients with clinical improvement. Consider discontinuing after 4 to 5 days in patients with no clinical response (IDSA [Pappas 2016]) Candidiasis, intravascular infections (native or prosthetic valve endocarditis, infection of implantable cardiac devices, suppurative thrombophlebitis) (off-label use): IV: 200 mg daily. For native or prosthetic valve endocarditis, therapy should continue for at least 6 weeks after valve replacement surgery (longer durations in patients with abscesses or other complications); for patients with implantable cardiac devices, therapy should continue for 4 to 6 weeks after surgery (4 weeks for infections limited to generator pockets and at least 6 weeks for infections involving the wires); for suppurative thrombophlebitis, continue for at least 2 weeks after candidemia has cleared. Note: Step-down to fluconazole therapy is recommended in clinically stable patients with fluconazole-susceptible isolates and negative repeat cultures (IDSA [Pappas 2016]) Candidiasis, osteoarticular infections (osteomyelitis or septic arthritis) (alternative therapy) (off-label use): IV: 100 mg daily for at least 14 days, followed by fluconazole (IDSA [Pappas 2016]) Candidiasis, prophylaxis against invasive candidiasis (high-risk ICU patients in units with a high incidence of invasive candidiasis) (alternative therapy; off-label use): IV: Initial dose: 200 mg on day 1; subsequent doses: 100 mg daily (IDSA [Pappas 2016]) Candidiasis, esophageal: IV: Manufacturer’s labeling: Initial dose: 100 mg on day 1; subsequent dosing: 50 mg daily; treatment should continue for a minimum of 14 days and for at least 7 days after symptom resolution Alternate recommendations: 200 mg daily; may transition to oral fluconazole therapy once oral intake tolerable. In patients with fluconazole-refractory disease, continue anidulafungin for 14 to 21 days (IDSA [Pappas 2016]) Candidiasis, oropharyngeal (refractory disease) (alternative therapy) (off-label use): IV: Initial dose: 200 mg on day 1; subsequent dosing: 100 mg daily (IDSA [Pappas 2016])