In vitro and in vivo interactions between fluconazole and allicin against clinical isolates of fluconazole-resistant Candida albicans determined by alternative methods

A checkerboard microdilution method, performed according to the recommendations of the National Committee for Clinical Laboratory Standards, was used to study the in vitro interaction of fluconazole and allicin in 24 fluconazole-resistant clinical isolates of Candida albicans, one experimentally induced strain S-1, and one ATCC type strain 10231. The interaction intensity was determined by spectrophotometric methods and visual reading of the checkerboard assay, and the nature of the interactions was assessed using two nonparametric approaches [fractional inhibitory concentration index (FICI) and delta E models]. Synergism was observed in 23 strains using FICI, and in 22 strains using delta E. The delta E model gave results consistent with FICI, but no antagonistic action was observed. The positive interactions were also confirmed by the time-killing test and agar diffusion in the selected strains. Moreover, the in vivo experiment showed that a combination of fluconazole and allicin exhibited a good synergism against C. albicans.