Mode of action of clotrimazole: implications for therapy

Ergosterol is an essential constituent of the fungal cytoplasmic membrane. Clotrimazole and other azoles interfere with the ergosterol biosynthesis in a concentration-dependent fashion. Although low concentrations exhibit only a partially inhibitory effect, high concentrations may completely block ergosterol synthesis. Reduction of fungal growth and inhibition of growth and fungicidal action during prolonged incubation are the corresponding effects at the cellular level that are a consequence of ergosterol depletion. The inoculum effect, the influence of the incubation period, and the influence of nutrient media, three factors that often complicate susceptibility testing in vitro, can also be explained by the mode of action of azole compounds. Another interesting characteristic of azole antifungals was revealed by the observation that hyphae and pseudomycelia of Candida albicans are much more susceptible to azoles than are yeast cells. Even 1% of the minimum inhibitory concentration of clotrimazole may totally inhibit mycelial growth in vitro. This may be of clinical importance, since germination was reported to enhance adherence of C. albicans to buccal and vaginal epithelial cells.