In VitroAntifungal Activity of Sertaconazole Against 309 Dermatophyte Clinical Isolates

Sertaconazole: updated review of a topical antifungal agent

Sertaconazole is an imidazole-type antifungal agent that has shown considerable in vitro activity against pathogenic fungi. Various studies carried out in animal models, clinical and toxicologic trials have confirmed the value of sertaconazole in the topical treatment of superficial mycoses in dermatology and gynecology. After several years of clinical experience in the topical treatment of dermatophytosis and Tinea versicolor, the substance has been approved for gynecologic candidiasis in Europe. Sertaconazole has a wide action spectrum that includes yeasts and dermatophyte fungi, and it is also active against bacteria, mainly Gram-positive cocci, making it highly efficient in the treatment of polymicrobial infections. The recent approval of the molecule by the US Food and Drug Administration, and the appearance of a new formulation of sertaconazole for the treatment of onychomycoses on a weekly administrative basis, are all data relevant to the process of marketing the product.

Sertaconazole: an antifungal agent for the topical treatment of superficial candidiasis

Sertaconazole is a useful antifungal agent against mycoses of the skin and mucosa, such as cutaneous, genital and oral candidiasis and tinea pedis. Its antifungal activity is due to inhibition of the ergosterol biosynthesis and disruption of the cell wall. At higher concentrations, sertaconazole is able to bind to nonsterol lipids of the fungal cell wall, increasing the permeability and the subsequent death of fungal cells. Fungistatic and fungicidal activities on Candida are dose-dependent. The antifungal spectrum of sertaconazole includes deramophytes, Candida, Cryptococcus, Malassezia and also Aspergillus, Scedosporium and Scopulariopsis. Sertaconazole also shows an antimicrobial activity against streptococci, staphylococci and protozoa (Trichomonas). In clinical trials including patients with vulvovaginal candidiasis, a single dose of sertaconazole produced a higher cure rate compared with other topical azoles such as econazole and clotrimazole, in shorter periods. Sertaconazole has shown an anti-inflammatory effect that is very useful for the relief of unpleasant symptoms.

Sertaconazole antifungal profile determined by a microdilution method versus nine topical substances against dermatophyte fungi

Antifungal activity and in vitro inhibition time for sertaconazole (STZ) and 9 other topical drugs, namely amorolfine, bifonazole, clotrimazole, econazole, ketoconazole, miconazole, oxiconazole, terbinafine, and tioconazole were determined against 124 clinical isolates of dermatophyte (12 species) fungi by the microdilution method in a liquid medium and the measurement of optical density. STZ's antifungal activity was not always affected by the tested dermatophyte genus, as was the case with the remaining antifungals. In vitro antifungal activity was at the same level for all the studied azole derivatives, but, in terms of partial inhibitory concentrations, STZ starts its in vitro inhibitory activity in a shorter time than the other tested substances, particularly in those incubation periods when the growth of the dermatophyte fungi was more developed.

Sertaconazole nitrate shows fungicidal and fungistatic activities against Trichophyton rubrum, Trichophyton mentagrophytes, and Epidermophyton floccosum, causative agents of tinea pedis

The fungistatic and fungicidal activities of sertaconazole against dermatophytes were evaluated by testing 150 clinical isolates of causative agents of tinea pedis, Trichophyton rubrum, Trichophyton mentagrophytes, and Epidermophyton floccosum. The overall geometric means for fungistatic and fungicidal activities of sertaconazole against these isolates were 0.26 and 2.26 μg/ml, respectively, although values were higher for T. mentagrophytes than for the others. This is the first comprehensive demonstration of the fungicidal activity of sertaconazole against dermatophytes.

In vitro antifungal activity of indirubin isolated from a South Indian ethnomedicinal plant Wrightia tinctoria R. Br

ETHNOPHARMACOLOGICAL RELEVANCE

Acalypha indica, Cassia alata, Lawsonia inermis, Punica granatum, Thespesia populnea and Wrightia tinctoria are folklore medicines extensively used in the treatment of ringworm infections and skin related diseases in Tamil Nadu, India.

AIM

The present study was designed to investigate the in vitro antifungal activity of certain medicinal plants and the pure compound indirubin isolated from Wrightia tinctoria.

MATERIALS AND METHODS

The hexane, chloroform, methanol and ethanol extracts of six different plants were investigated against dermatophytes, non-dermatophytes and yeasts. Chloroform extract of Wrightia tinctoria leaf was fractionated using column chromatography and the major compound was identified using spectroscopic techniques. Antifungal activity was studied by spore germination test using agar dilution method. The minimum inhibitory concentration (MIC) was determined using broth microdilution method.

RESULTS

Wrightia tinctoria showed promising activity against dermatophytic and non-dermatophytic fungi. Leaf chloroform extract showed activity at 0.5 mg/ml against Trichophyton rubrum, Epidermophyton floccosum, Aspergillus niger and Scopulariopsis brevicaulis. The major compound, identified as indirubin, exhibited activity against dermatophytes such as Epidermophyton floccosum (MIC=6.25 μg/ml); Trichophyton rubrum and Trichophyton tonsurans (MIC=25 μg/ml); Trichophyton mentagrophytes and Trichophyton simii (MIC=50 μg/ml). It was also active against non-dermatophytes (Aspergillus niger, Candida albicans and Cryptococcus sp.) within a MIC range of 0.75-25 μg/ml.

CONCLUSION

The indole compound indirubin from Wrightia tinctoria showed antifungal activity and may be useful in the treatment of dermatophytosis.

Comparative study of 2% sertaconazole solution and cream formulations in patients with tinea corporis, tinea pedis interdigitalis, or a corresponding candidosis

BACKGROUND

Based on the results of numerous preclinical and clinical studies, sertaconazole can be considered a safe and effective drug for the treatment of fungal skin infections.

OBJECTIVE

The objective of the study was to compare the efficacy of a solution containing 2% sertaconazole with the well established 2% sertaconazole cream formulation in patients with tinea corporis, tinea pedis interdigitalis, or a corresponding candidosis.

METHODS

This was a prospective, open-label, randomized, controlled, parallel-group, multicenter, noninferiority therapy study. Patients received either sertaconazole solution or cream twice daily for 28 days. The full analysis set comprised 160 patients in the solution group and 153 patients in the cream group. The primary efficacy parameter was a combination of culture test result and total clinical score. Efficacy was defined by eradication of the pathogen and reduction of the total clinical score between pretreatment and the final visit.

RESULTS

Efficacy was documented in 90.6% of patients using the solution and 88.9% of those using the cream (full analysis set). No adverse events occurred.

CONCLUSION

Solution and cream formulations of 2% sertaconazole applied for 28 days were associated with comparable efficacy and safety in the treatment of fungal skin infections.

Anti-inflammatory and anti-itch activity of sertaconazole nitrate

Cutaneous fungal infections are frequently associated with an inflammatory component including irritated skin, itching and stinging/burning. Therapeutic anti-fungal agents that have anti-inflammatory activity have the potential to provide clinical benefit beyond fungus eradication. Recently, certain anti-fungal agents have been shown to have intrinsic anti-inflammatory activity, therefore we sought to determine the extent of the anti-inflammatory activity of these compounds. The anti-inflammatory activities of eight anti-fungal agents (butoconazole, ciclopirox olamine, fluconazole, miconazole nitrate, sertaconazole nitrate, terconazole, tioconazole and ketoconazole) were compared in a number of preclinical models of dermal inflammation and pruritus. While butoconazole, ciclopirox olamine, fluconazole, and miconazole nitrate were all found to have anti-inflammatory activity, only sertaconazole nitrate reduced the release of cytokines from activated lymphocytes and mitigated inflammation in animal models of irritant contact dermatitis and neurogenic inflammation. In addition, sertaconazole nitrate inhibited contact hypersensitivity and scratching responses in a murine model of pruritus. Furthermore, the in vitro and in vivo anti-inflammatory activity of sertaconazole nitrate was found to be greater than other topical anti-fungal agents examined. These studies demonstrate that topical administration of clinically relevant concentrations of sertaconazole nitrate resulted in an efficacious anti-inflammatory activity against a broad spectrum of dermal inflammation models and itch. The anti-inflammatory properties of sertaconazole may contribute to the efficacy of the drug in the treatment of cutaneous fungal conditions and provide greater anti-inflammatory activity compared with other anti-fungal agents.

Antifungal susceptibility and genotypical pattern ofMicrosporum canisstrains

Dermatophytes are a group of fungi that are capable of invading keratinized tissues of humans and other animals. Antifungal susceptibility analysis and genetic studies by random amplification of polymorphic DNA (RAPD), have been used to detect polymorphism as well as determining the possible resistance of dermatophytes to antifungals. The aim of this study was to evaluate the possible correlation between the antifungal susceptibility and genotypical pattern of Microsporum canis strains isolated in dogs and cats with dermatophytosis in Northeast Brazil. The antifungal susceptibility study was conducted using the broth microdilution test with griseofulvine, ketoconazole, itraconazole, and fluconazole. The genotypical analysis was performed using the RAPD method. The antifungal susceptibility analysis showed that all the strains of M. canis analyzed (n = 22) were sensitive to griseofulvine (0.25 µg/mL ≤ minimum inhibitory concentration (MIC) ≤ 1 µg/mL), ketoconazole (0.25 µg/mL ≤ MIC ≤ 2 µg/mL), itraconazole (0.25 µg/mL ≤ MIC ≤ 1 µg/mL), and fluconazole (1 µg/mL ≤ MIC ≤ 16 µg/mL). The RAPD results showed that all analyzed strains are genetically similar. Thus, based on antifungal susceptibility analysis and RAPD data, a possible correlation can be shown between the antifungal susceptibility and the genotypical pattern of the strains of M. canis from Northeast Brazil.Key words: Microsporum canis, antifungal susceptibility testing, RAPD.

Actividad antifúngica in vitro de voriconazol contra dermatofitos y aislamientos superficiales de Scopulariopsis brevicaulis

We have studied the in vitro antifungal activity of voriconazole, fluconazole and itraconazole against 252 clinical isolates of dermatophytes and Scopulariopsis brevicaulis by a standardized agar diffusion method (NeoSensitabs). Several important factors such as temperature (28 degrees C vs. 35 degrees C) and incubation time (2-10 days vs. 18-74 h) were adapted to dermatophytes and Scopulariopsis requirements. Voriconazole showed an excellent activity against most species of dermatophytes, higher than itraconazole and fluconazole. However, S. brevicaulis isolates were highly resistant to all azoles used in this study. Voriconazole might be an interesting antifungal alternative to refractory superficial mycoses.