ID:IOTS - Infectious Disease Insight Of Two Specialists 133. Echinocandins Part 2: Rezafungin
Mar 2, 2026
Tihana Bicanic, an infectious diseases clinician and mycology expert, leads a deep dive on rezafungin with trial updates and practical OPAT experience. They cover weekly dosing and PK/PD, resistance concerns during the long drug tail, ICU and OPAT logistics, off-license uses for difficult infections, and cost versus hospital discharge tradeoffs.
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Rezafungin Efficacy And Dosing
- Rezafungin is non-inferior to caspofungin for invasive candidiasis based on STRIVE and RESTORE trials leading to UK licensing in Jan 2024.
- Dosing is 400 mg loading day one then 200 mg weekly, producing high early concentrations and a long half-life (~150 hours).
Front Loaded PK Creates Early Killing But Theoretical Tail Risk
- Rezafungin's PK shows a high front-loaded concentration and a long tail which may speed early killing compared with daily echinocandins.
- Theoretical concern exists about low tail concentrations at days 5–7 in poorly penetrated sites possibly risking resistance, but no evidence yet.
Use Rezafungin To Facilitate OPAT Discharge
- Use rezafungin to facilitate OPAT discharge when antifungal therapy is the main barrier to leaving hospital.
- It’s most helpful for patients needing prolonged courses (e.g., endovascular, bone/joint) where weekly dosing enables home treatment.