Anidulafungin for neonatal hematogenous Candida meningoencephalitis: Identification of candidate regimens for humans using a translational pharmacological approach

Peter A. Warn, Joanne Livermore, Susan Howard, Timothy W. Felton, Andrew Sharp, Lea Gregson, Joanne Goodwin, Ruta Petraitiene, Vidmantas Petraitis, Michael Cohen-Wolkowiez, Thomas J. Walsh, Daniel K. Benjamin, William W. Hope

Research output: Contribution to journalArticle

Abstract

Hematogenous Candida meningoencephalitis (HCME) is a serious infection in premature neonates. Anidulafungin is an echinocandin antifungal agent with potent activity against Candida spp., but its efficacy and optimal regimens for human neonates with HCME are not known. A well-validated rabbit model of HCME was used to define pharmacokinetic-pharmacodynamic (PK-PD) relationships of anidulafungin. A mathematical model was fitted to the entire data set. The experimental data were bridged to humans. A population PK model was fitted to the data from human neonates receiving anidulafungin receiving a loading dose of 3 mg/kg, followed by 1.5 mg/kg/day. Monte Carlo simulations were performed to identify candidate anidulafungin regimens for humans. All untreated rabbits succumbed by ≤96 h postinoculation. The PK of anidulafungin was linear with dose-dependent penetration into the cerebrum. Anidulafungin exerted a rapid antifungal effect that was apparent in the first dosing interval. Near-maximal antifungal activity was observed with dosages of 10 to 20 mg/kg/day. The bridging studies suggested that the current regimen of first 3 mg/kg, followed by 1.5 mg/kg/day, is suboptimal. Higher dosages were associated with progressively greater antifungal effect. Anidulafungin is effective for the treatment of experimental HCME. Higher dosages than those currently used for clinical care are required for maximal antifungal effect.

Original languageEnglish (US)
Pages (from-to)708-714
Number of pages7
JournalAntimicrobial agents and chemotherapy
Volume56
Issue number2
DOIs
StatePublished - Feb 1 2012

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)
  • Infectious Diseases

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    Warn, P. A., Livermore, J., Howard, S., Felton, T. W., Sharp, A., Gregson, L., Goodwin, J., Petraitiene, R., Petraitis, V., Cohen-Wolkowiez, M., Walsh, T. J., Benjamin, D. K., & Hope, W. W. (2012). Anidulafungin for neonatal hematogenous Candida meningoencephalitis: Identification of candidate regimens for humans using a translational pharmacological approach. Antimicrobial agents and chemotherapy, 56(2), 708-714. https://doi.org/10.1128/AAC.05826-11