Davidson H C, Yau T, Dunstan I, Houston A, Basarab M, Bicanic T
Institute of Infection and Immunity, St George's School of Health and Medical Sciences, City St George's University of London, London SW17 0RE, UK.
ECMM Excellence Center, St George's University Hospitals NHS Foundation Trust, London SW17 0QT, UK.
J Antimicrob Chemother. 2025 Jul 1;80(7):1885-1892. doi: 10.1093/jac/dkaf143.
Rezafungin is a novel echinocandin with a unique structural configuration enabling weekly IV dosing. We report on early use of rezafungin in our outpatient parenteral antibiotic therapy (OPAT) service, reviewing indications, treatment regimens, outcomes and adverse events in adult patients receiving rezafungin at a tertiary infectious disease centre. We also review published cases of rezafungin use, licensing trials, spectrum and pharmacokinetics/pharmacodynamics and how that might relate to its propensity to generate resistance (in comparison with daily echinocandins).
All adult patients who received rezafungin therapy via the OPAT service in 2024-25 were included. Patient demographics, infections, treatment regimens and outcomes were recorded.
Six patients (age range 30-84 years) received rezafungin therapy between July 2024 and February 2025. Indications included invasive and mucocutaneous candidiasis, predominantly caused by azole-resistant Candida species. We also report the first case of using rezafungin in combination with voriconazole to treat azole-refractory pulmonary aspergillosis. Rezafungin courses were a median length of 4 doses (range: 2-5) and were generally well tolerated with no laboratory adverse events. Reasons for choosing rezafungin over daily echinocandins were patient preference/convenience (n = 5), concern regarding azole resistance (n = 4) and facilitation of earlier discharge (n = 2). One hundred and fifty-seven days with an IV catheter were saved through once-weekly dosing. Outcomes were positive, with all patients showing mycological clearance.
Early use of rezafungin at our centre and in the international literature suggests it is a well-tolerated, convenient and useful addition to the antifungal armamentarium, particularly in the outpatient setting.
瑞扎芬净是一种新型棘白菌素，具有独特的结构构型，能够每周静脉给药一次。我们报告了瑞扎芬净在我们的门诊肠外抗生素治疗（OPAT）服务中的早期应用情况，回顾了在一家三级传染病中心接受瑞扎芬净治疗的成年患者的适应证、治疗方案、治疗结果及不良事件。我们还回顾了已发表的瑞扎芬净使用病例、许可试验、抗菌谱以及药代动力学/药效学情况，以及这些与它产生耐药性的倾向（与每日给药的棘白菌素相比）之间的关系。
纳入2024年至2025年期间通过OPAT服务接受瑞扎芬净治疗的所有成年患者。记录患者的人口统计学信息、感染情况、治疗方案及治疗结果。
2024年7月至2025年2月期间，6例患者（年龄范围30 - 84岁）接受了瑞扎芬净治疗。适应证包括侵袭性和黏膜皮肤念珠菌病，主要由对唑类耐药的念珠菌属引起。我们还报告了首例瑞扎芬净联合伏立康唑治疗对唑类难治的肺曲霉病的病例。瑞扎芬净疗程的中位数为4剂（范围：2 - 5剂），总体耐受性良好，未发生实验室不良事件。相较于每日给药的棘白菌素，选择瑞扎芬净的原因包括患者偏好/便利性（n = 5）、对唑类耐药的担忧（n = 4）以及便于更早出院（n = 2）。通过每周给药一次，节省了157天的静脉导管使用时间。治疗结果良好，所有患者均实现真菌清除。
我们中心及国际文献中瑞扎芬净的早期应用表明，它是一种耐受性良好、方便且有用的抗真菌药物，尤其在门诊环境中。
