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Published on: October 21, 2010
Testing of antifungal combinations against yeasts and dermatophytes
S Harman1, H R Ashbee, E G V Evans
1Mycology Reference Centre, Division of Microbiology, University of Leeds and General Infirmary, Leeds, UK.
Background:
Fungal infections of the nail are a common and chronic problem. The main pathogens responsible for onychomycosis are dermatophytes, yeasts and moulds. Despite significant improvements, approximately 20% of patients with onychomycosis still fail on antifungal therapy. The successful exploitation of drug synergy may provide a useful approach to improve cure rates.
Methods:
The minimum inhibitory concentrations (MIC(80)) were recorded for pathogens that are most frequently responsible for onychomycosis against combinations of several antifungal agents, namely, fluconazole, itraconazole, terbinafine and amorolfine. Fractional inhibitory concentrations (FICs) were then calculated from the MIC(80) results and the FIC values for each drug in the combinations added to determine the degree of synergy. A combined value of <1 was taken to suggest synergy; a value of 1-2 indicated an additive effect or indifference; and a combined FIC value of >2 was taken to suggest antagonism.
Results:
Overall, 46% of amorolfine combinations showed results suggestive of synergy, with the most synergistic results seen against dermatophytes (54%) and moulds (52%).
Conclusions:
Some combinations of drugs may have synergistic activity in vitro; however, the importance of this in a clinical setting is yet to be established, and more studies are justified.
Insights
Investigating antifungal drug combinations for nail fungus (onychomycosis), researchers found that 46% of amorolfine combinations showed synergistic effects in vitro. This suggests potential for improved treatment outcomes in fungal nail infections.
Area of Science:
- Medical Mycology
- Pharmacology
- Antimicrobial Resistance
Background:
- Onychomycosis, a chronic fungal nail infection, affects approximately 20% of patients.
- Dermatophytes, yeasts, and moulds are the primary causative agents of onychomycosis.
- Current antifungal therapies have limitations, with a significant percentage of patients experiencing treatment failure.
Purpose of the Study:
- To evaluate the in vitro synergistic activity of combined antifungal agents against common onychomycosis pathogens.
- To explore novel therapeutic strategies for improving cure rates in fungal nail infections.
Main Methods:
- Determined minimum inhibitory concentrations (MIC80) for fluconazole, itraconazole, terbinafine, and amorolfine against key onychomycosis pathogens.
- Calculated fractional inhibitory concentrations (FICs) to assess drug synergy, with FIC < 1 indicating synergy.
Main Results:
- 46% of tested antifungal combinations exhibited synergistic activity.
- Amorolfine combinations demonstrated the highest synergy rates, particularly against dermatophytes (54%) and moulds (52%).
Conclusions:
- In vitro studies suggest potential synergistic interactions among certain antifungal drug combinations.
- Further clinical research is warranted to establish the therapeutic significance of these synergistic combinations for onychomycosis treatment.
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