Early use of the novel antifungal rezafungin: a case series and literature review
Bibliographic record
Abstract
OBJECTIVES: 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). METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".