Journal
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY
Volume 65, Issue 8, Pages -Publisher
AMER SOC MICROBIOLOGY
DOI: 10.1128/AAC.00321-21
Keywords
synergy; dermatophytes; tinea corporis/cruris; terbinafine; itraconazole; PGMC; resistance; SQLE mutations; fractional inhibitory concentration; checkerboard analysis; ketoconazole; fluconazole; luliconazole
Categories
Funding
- Vyome Therapeutics Limited, New Delhi, India
Ask authors/readers for more resources
This study aimed to test the synergistic combinations of oral and topical antifungals for treating recalcitrant tinea corporis/cruris. It was found that many isolates showed high MICs of terbinafine, but synergistic interactions were noted with combinations of itraconazole with luliconazole and other drugs.
Recalcitrant dermatophytic infections of the glabrous skin (tinea corporis/cruris/faciei) pose a huge challenge to health care systems. Combinations of oral and topical drugs may potentially improve cure rates, but the same has never been objectively assessed for this condition in laboratory or clinical studies. The present study was undertaken with the aim of identifying synergistic combinations of oral and topical antifungals by testing clinical isolates obtained from patients with recalcitrant tinea corporis/cruris. Forty-two patients with tinea corporis/cruris who had failed oral antifungals or had relapsed within 4 weeks of apparent clinical cure were recruited. Twenty-one isolates were identified by sequencing (all belonging to the Trichophyton mentagrophytes/T. interdigitale species complex) and subjected to anti-fungal susceptibility testing (AFST) and squalene epoxidase (SQLE) gene mutation analysis. Finally, five isolates, four with underlying SQLE gene mutations and one wild-type strain, were chosen for checkerboard studies using various combinations of antifungal agents. Most isolates (n = 16) showed high MICs of terbinafine (TRB) (0.5 to >16 mu g/ml), with SQLE gene mutations being present in all isolates with MICs of >= 0.5 mu g/ml. Synergistic interactions were noted with combinations of itraconazole with luliconazole, TRB, and ketoconazole and propylene glycol monocaprylate (PGMC) with luliconazole and with the triple combination of PGMC with luliconazole and ketoconazole. In vitro synergistic interactions provide a sound scientific basis for the possible clinical use of antifungal combinations. Hence, these synergistic combinations may be tested for clinical utility in the wake of rising resistance among dermatophytic infections of the glabrous skin.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available