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Morón-Ocaña JM, Coronel-Pérez IM, Rodríguez-Rey EM. Terbinafine as a successful treatment in primary cutaneous aspergillosis. An Bras Dermatol 2024; 99:647-649. [PMID: 38653610 PMCID: PMC11221157 DOI: 10.1016/j.abd.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/08/2023] [Accepted: 07/10/2023] [Indexed: 04/25/2024] Open
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Sonego B, Corio A, Mazzoletti V, Zerbato V, Benini A, di Meo N, Zalaudek I, Stinco G, Errichetti E, Zelin E. Trichophyton indotineae, an Emerging Drug-Resistant Dermatophyte: A Review of the Treatment Options. J Clin Med 2024; 13:3558. [PMID: 38930086 PMCID: PMC11204959 DOI: 10.3390/jcm13123558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 06/11/2024] [Accepted: 06/15/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Dermatophytosis is a prevalent superficial infection caused by filamentous fungi, primarily affecting the skin and/or its appendages. In recent years, there has been a notable increase in mycotic strains resistant to standard antifungal therapies, including Trichophyton indotineae, a dermatophyte of the Trichophyton mentagrophytes complex. This review aims to provide a comprehensive overview of the treatment options for T. indotineae, elucidating their effectiveness in managing this challenging mycotic infection. Methods: For this review, a search was conducted in the PubMed, Scopus, Web of Science, Embase, and Google Scholar databases, encompassing all published data until March 2024. English-language articles detailing therapy outcomes for patients confirmed to be affected by T. indotineae, identified through molecular analysis, were included. Results: Itraconazole was shown to be a good therapeutic choice, particularly when administered at a dosage of 200 mg/day for 1-12 weeks. Voriconazole was also demonstrated to be effective, while terbinafine exhibited a reduced response rate. Griseofulvin and fluconazole, on the other hand, were found to be ineffective. Although topical treatments were mostly ineffective when used alone, they showed promising results when used in combination with systemic therapy. Mutational status was associated with different profiles of treatment response, suggesting the need for a more tailored approach. Conclusions: When managing T. indotineae infections, it is necessary to optimize therapy to mitigate resistances and relapse. Combining in vitro antifungal susceptibility testing with mutational analysis could be a promising strategy in refining treatment selection.
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Affiliation(s)
- Benedetta Sonego
- Dermatology Clinic, Maggiore Hospital, University of Trieste, 34125 Trieste, Italy; (B.S.); (A.C.); (A.B.); (N.d.M.); (I.Z.)
| | - Andrea Corio
- Dermatology Clinic, Maggiore Hospital, University of Trieste, 34125 Trieste, Italy; (B.S.); (A.C.); (A.B.); (N.d.M.); (I.Z.)
| | - Vanessa Mazzoletti
- Institute of Dermatology, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy;
| | - Verena Zerbato
- Infectious Diseases Unit, Trieste University Hospital (ASUGI), 34125 Trieste, Italy;
| | - Alessandro Benini
- Dermatology Clinic, Maggiore Hospital, University of Trieste, 34125 Trieste, Italy; (B.S.); (A.C.); (A.B.); (N.d.M.); (I.Z.)
| | - Nicola di Meo
- Dermatology Clinic, Maggiore Hospital, University of Trieste, 34125 Trieste, Italy; (B.S.); (A.C.); (A.B.); (N.d.M.); (I.Z.)
| | - Iris Zalaudek
- Dermatology Clinic, Maggiore Hospital, University of Trieste, 34125 Trieste, Italy; (B.S.); (A.C.); (A.B.); (N.d.M.); (I.Z.)
| | - Giuseppe Stinco
- Institute of Dermatology, Department of Medicine, University of Udine, 33100 Udine, Italy; (G.S.); (E.E.)
| | - Enzo Errichetti
- Institute of Dermatology, Department of Medicine, University of Udine, 33100 Udine, Italy; (G.S.); (E.E.)
| | - Enrico Zelin
- Institute of Dermatology, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy;
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Gupta AK, Polla Ravi S, Talukder M, Mann A. Effectiveness and safety of oral terbinafine for dermatophyte distal subungual onychomycosis. Expert Opin Pharmacother 2024; 25:15-23. [PMID: 38221907 DOI: 10.1080/14656566.2024.2305304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/10/2024] [Indexed: 01/16/2024]
Abstract
INTRODUCTION Terbinafine has been a cornerstone in dermatophyte infection treatment. Despite its global efficacy, the emergence of terbinafine resistance raises concerns, requiring ongoing vigilance. AREAS COVERED This paper focuses on evaluating the efficacy and safety of terbinafine in treating dermatophyte toenail infections. Continuous and pulse therapies, with a 24-week continuous regimen and a higher dosage of 500 mg/day have demonstrated superior efficacy to the FDA approved regimen of 250 mg/day x 12 weeks. Pulse therapies, though showing comparable effectiveness, present debates with regards to their efficacy as conflicting findings have been reported. Safety concerns encompass hepatotoxicity, gastrointestinal, cutaneous, neurologic, hematologic and immune adverse-effects, and possible drug interactions, suggesting the need for ongoing monitoring. EXPERT OPINION Terbinafine efficacy depends on dosage, duration, and resistance patterns. Continuous therapy for 24 weeks and a dosage of 500 mg/day may enhance outcomes, but safety considerations and resistance necessitate individualized approaches. Alternatives, including topical agents and alternative antifungals, are to be considered for resistant cases. Understanding the interplay between treatment parameters, adverse effects, and resistance mechanisms is critical for optimizing therapeutic efficacy while mitigating resistance risks. Patient education and adherence are vital for early detection and management of adverse effects and resistance, contributing to tailored and effective treatments.
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Affiliation(s)
- Aditya K Gupta
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Research Department, Mediprobe Research Inc, London, Ontario, Canada
| | | | - Mesbah Talukder
- Research Department, Mediprobe Research Inc, London, Ontario, Canada
- School of Pharmacy, BRAC University, Dhaka, Bangladesh
| | - Avantika Mann
- Research Department, Mediprobe Research Inc, London, Ontario, Canada
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Haynes E, Stanford K, Cox S, Vivirito K, Durante K, Wright A, Gramhofer M, Pohly A, Gartlan B, Fredrickson K, Allender MC. CONTROLLED CLINICAL TRIAL USING TERBINAFINE NEBULIZATION TO TREAT WILD LAKE ERIE WATERSNAKES ( NERODIA SIPEDON INSULARUM) WITH OPHIDIOMYCOSIS. J Zoo Wildl Med 2024; 54:746-756. [PMID: 38251998 DOI: 10.1638/2023-0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2023] [Indexed: 01/23/2024] Open
Abstract
Ophidiomycosis (snake fungal disease) is an important infectious disease caused by the fungus Ophidiomyces ophidiicola. To mitigate the disease's impact on individual snakes, a controlled clinical trial was conducted using terbinafine nebulization to treat snakes with ophidiomycosis. Fifty-three wild-caught Lake Erie watersnakes (Nerodia sipedon insularum) with apparent ophidiomycosis (skin lesions present, qPCR positive for O. ophidiicola) were divided into treatment and control groups: treatment snakes were nebulized with a 2 mg/ml terbinafine solution for 30 min daily for 30 d; control snakes received nebulization with 0.9% saline or no nebulization. Weekly physical exams were conducted to assign disease severity scores based on the number, type, location, and size of lesions, and qPCR was repeated after each 30-d course of treatment. Persistently qPCR-positive snakes received multiple nebulization courses. Terbinafine nebulization showed mixed results as a treatment for ophidiomycosis: 29.2% of animals treated with terbinafine showed molecular resolution of external disease, based on antemortem swabbing, following 3-6 mon of daily nebulization; this was significantly more than with saline nebulization (5%), but molecular resolution also occurred in 11.1% of snakes that received no treatment. Terbinafine nebulization did not significantly decrease clinical disease, as measured by disease severity scores. Evaluating molecular response to treatment using fungal quantities, terbinafine nebulization significantly reduced fungal quantity after three or more courses of treatment. These results indicate that, although terbinafine nebulization is a promising treatment for ophidiomycosis, snakes may require multiple nebulization courses and disease may not always resolve completely, despite treatment. This treatment may be most useful in snakes from managed populations that can be treated for several months, rather than wild snakes who are not releasable after multiple months in captivity.
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Affiliation(s)
- Ellen Haynes
- Wildlife Epidemiology Laboratory, University of Illinois Urbana-Champaign, Urbana, IL 61802, USA,
| | - Kristin Stanford
- Franz Theodore Stone Laboratory, The Ohio State University, OH 43456, USA
| | - Sherry Cox
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996, USA
| | - Kathryn Vivirito
- Wildlife Epidemiology Laboratory, University of Illinois Urbana-Champaign, Urbana, IL 61802, USA
| | - Kennymac Durante
- Wildlife Epidemiology Laboratory, University of Illinois Urbana-Champaign, Urbana, IL 61802, USA
| | - Allison Wright
- Wildlife Epidemiology Laboratory, University of Illinois Urbana-Champaign, Urbana, IL 61802, USA
| | - Megan Gramhofer
- Wildlife Epidemiology Laboratory, University of Illinois Urbana-Champaign, Urbana, IL 61802, USA
| | - Andrea Pohly
- University of Illinois Veterinary Diagnostic Laboratory, Urbana, IL 61802, USA
| | - Brina Gartlan
- Wildlife Epidemiology Laboratory, University of Illinois Urbana-Champaign, Urbana, IL 61802, USA
| | - Kelcie Fredrickson
- Wildlife Epidemiology Laboratory, University of Illinois Urbana-Champaign, Urbana, IL 61802, USA
| | - Matthew C Allender
- Wildlife Epidemiology Laboratory, University of Illinois Urbana-Champaign, Urbana, IL 61802, USA
- Chicago Zoological Society, Brookfield Zoo, Brookfield, IL 60513, USA
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Blanchard G, Amarov B, Fratti M, Salamin K, Bontems O, Chang YT, Sabou AM, Künzle N, Monod M, Guenova E. Reliable and rapid identification of terbinafine resistance in dermatophytic nail and skin infections. J Eur Acad Dermatol Venereol 2023; 37:2080-2089. [PMID: 37319111 DOI: 10.1111/jdv.19253] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 05/05/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Fungal infections are the most frequent dermatoses. The gold standard treatment for dermatophytosis is the squalene epoxidase (SQLE) inhibitor terbinafine. Pathogenic dermatophytes resistant to terbinafine are an emerging global threat. Here, we determine the proportion of resistant fungal skin infections, analyse the molecular mechanisms of terbinafine resistance, and validate a method for its reliable rapid identification. METHODS Between 2013 and 2021, we screened 5634 consecutively isolated Trichophyton for antifungal resistance determined by hyphal growth on Sabouraud dextrose agar medium containing 0.2 μg/mL terbinafine. All Trichophyton isolates with preserved growth capacity in the presence of terbinafine underwent SQLE sequencing. Minimum inhibitory concentrations (MICs) were determined by the broth microdilution method. RESULTS Over an 8-year period, the proportion of fungal skin infections resistant to terbinafine increased from 0.63% in 2013 to 1.3% in 2021. Our routine phenotypic in vitro screening analysis identified 0.83% (n = 47/5634) of Trichophyton strains with in vitro terbinafine resistance. Molecular screening detected a mutation in the SQLE in all cases. Mutations L393F, L393S, F397L, F397I, F397V, Q408K, F415I, F415S, F415V, H440Y, or A398 A399 G400 deletion were detected in Trichophyton rubrum. Mutations L393F and F397L were the most frequent. In contrast, all mutations detected in T. mentagrophytes/T. interdigitale complex strains were F397L, except for one strain with L393S. All 47 strains featured significantly higher MICs than terbinafine-sensitive controls. The mutation-related range of MICs varied between 0.004 and 16.0 μg/mL, with MIC as low as 0.015 μg/mL conferring clinical resistance to standard terbinafine dosing. CONCLUSIONS Based on our data, we propose MIC of 0.015 μg/mL as a minimum breakpoint for predicting clinically relevant terbinafine treatment failure to standard oral dosing for dermatophyte infections. We further propose growth on Sabouraud dextrose agar medium containing 0.2 μg/mL terbinafine and SQLE sequencing as fungal sporulation-independent methods for rapid and reliable detection of terbinafine resistance.
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Affiliation(s)
- Gabriela Blanchard
- Department of Dermatology, Lausanne University Hospital, CHUV, Lausanne, Switzerland
| | - Boyko Amarov
- Institute of Statistics and Econometrics, Sofia University "St. Kliment Ohridski," Faculty of Economics and Business Administration, Sofia, Bulgaria
| | - Marina Fratti
- Department of Dermatology, Lausanne University Hospital, CHUV, Lausanne, Switzerland
| | - Karine Salamin
- Department of Dermatology, Lausanne University Hospital, CHUV, Lausanne, Switzerland
| | - Olympia Bontems
- Department of Dermatology, Lausanne University Hospital, CHUV, Lausanne, Switzerland
| | - Yun-Tsan Chang
- Department of Dermatology, Lausanne University Hospital, CHUV, Lausanne, Switzerland
| | - Alina Marcela Sabou
- Laboratoire de Parasitologie et Mycologie Médicale, Plateau Technique de Microbiologie, University Hospital of Strasbourg, Strasbourg, France
| | | | - Michel Monod
- Department of Dermatology, Lausanne University Hospital, CHUV, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Emmanuella Guenova
- Department of Dermatology, Lausanne University Hospital, CHUV, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Department of Dermatology, Hospital 12 de octubre, Medical School, University Complutense, Madrid, Spain
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Ouyang J, Yan J, Zhou X, Isnard S, Tang S, Costiniuk CT, Chen Y, Routy JP, Chen Y. The Influence of Oral Terbinafine on Gut Fungal Microbiome Composition and Microbial Translocation in People Living with HIV Treated for Onychomycosis. J Fungi (Basel) 2023; 9:963. [PMID: 37888218 PMCID: PMC10607585 DOI: 10.3390/jof9100963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/19/2023] [Accepted: 09/19/2023] [Indexed: 10/28/2023] Open
Abstract
People living with HIV (PLWH) display altered gut epithelium that allows for the translocation of microbial products, contributing to systemic immune activation. Although there are numerous studies which examine the gut bacterial microbiome in PLWH, few studies describing the fungal microbiome, or the mycobiome, have been reported. Like the gut bacterial microbiome, the fungal microbiome and its by-products play a role in maintaining the body's homeostasis and modulating immune function. We conducted a prospective study to assess the effects of oral terbinafine, an antifungal agent widely used against onychomycosis, on gut permeability and microbiome composition in ART-treated PLWH (trial registration: ChiCTR2100043617). Twenty participants completed all follow-up visits. During terbinafine treatment, the levels of the intestinal fatty acid binding protein (I-FABP) significantly increased, and the levels of interleukin-6 (IL-6) significantly decreased, from baseline to week 12. Both markers subsequently returned to pre-treatment levels after terbinafine discontinuation. After terbinafine treatment, the abundance of fungi decreased significantly, while the abundance of the bacteria did not change. After terbinafine discontinuation, the abundance of fungi returned to the levels observed pre-treatment. Moreover, terbinafine treatment induced only minor changes in the composition of the gut bacterial and fungal microbiome. In summary, oral terbinafine decreases fungal microbiome abundance while only slightly influencing gut permeability and microbial translocation in ART-treated PLWH. This study's findings should be validated in larger and more diverse studies of ART-treated PLWH; our estimates of effect size can be used to inform optimal sample sizes for future studies.
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Affiliation(s)
- Jing Ouyang
- Clinical Research Center, Chongqing Public Health Medical Center, Chongqing 400036, China; (J.O.); (Y.C.)
| | - Jiangyu Yan
- Department of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing 400036, China; (J.Y.); (S.T.)
| | - Xin Zhou
- Department of Pharmacy, Chongqing Public Health Medical Center, Chongqing 400036, China;
| | - Stéphane Isnard
- Infectious Diseases and Immunity in Global Health Program, Research Institute, McGill University Health Centre, Montréal, QC H4A 3J1, Canada; (S.I.); (C.T.C.)
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Shengquan Tang
- Department of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing 400036, China; (J.Y.); (S.T.)
| | - Cecilia T. Costiniuk
- Infectious Diseases and Immunity in Global Health Program, Research Institute, McGill University Health Centre, Montréal, QC H4A 3J1, Canada; (S.I.); (C.T.C.)
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Yaling Chen
- Clinical Research Center, Chongqing Public Health Medical Center, Chongqing 400036, China; (J.O.); (Y.C.)
| | - Jean-Pierre Routy
- Infectious Diseases and Immunity in Global Health Program, Research Institute, McGill University Health Centre, Montréal, QC H4A 3J1, Canada; (S.I.); (C.T.C.)
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- Division of Hematology, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Yaokai Chen
- Department of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing 400036, China; (J.Y.); (S.T.)
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Colosi IA, Crișan M, Țoc DA, Colosi HA, Georgiu C, Sabou M, Costache C. First Reported Case of a Clinically Nonresponsive-to-Itraconazole Alternaria alternata Isolated from a Skin Infection of a Nonimmunocompromised Patient from Romania. J Fungi (Basel) 2023; 9:839. [PMID: 37623610 PMCID: PMC10455085 DOI: 10.3390/jof9080839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/12/2023] [Accepted: 08/07/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Alternaria alternata is a melanic fungus capable of causing a wide variety of infections, some of which have lethal potential. It is a ubiquitous fungus and a well-known plant pathogen. Cutaneous infections with Alternaria alternata most often occur in the extremities of patients who perform conventional agriculture, thus being exposed to occupational hazards leading to the disruption of the skin barrier. METHODS This paper presents the first case report from Romania of an itraconazole nonresponsive cutaneous alternariosis in a patient without any type of immunosuppression. RESULTS After an initial misdiagnosis regarding the etiology of the patient's skin infection, two successive punch biopsies, followed by mycologic examination, lead to the final diagnosis of cutaneous alternariosis. Treatment guided by antifungal susceptibility testing has been instituted, leading to the gradual healing of the patient's skin ulcerations. CONCLUSIONS The ability of Alternaria alternata to infect immunocompetent human hosts and to develop resistance to antifungal drugs highlight the importance of correctly diagnosing the etiology of skin ulcerations and instituting appropriate treatment guided by antifungal susceptibility testing whenever the suspicion of a fungal skin infection is plausible.
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Affiliation(s)
- Ioana Alina Colosi
- Microbiology Department, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Maria Crișan
- Histology Department, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Cluj County Emergency Hospital, 400000 Cluj-Napoca, Romania
| | - Dan Alexandru Țoc
- Microbiology Department, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Horațiu Alexandru Colosi
- Division of Medical Informatics and Biostatistics, Department of Medical Education, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
| | - Carmen Georgiu
- Cluj County Emergency Hospital, 400000 Cluj-Napoca, Romania
- Pathological Anatomy Department, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
| | - Marcela Sabou
- Institut de Parasitologie et de Pathologie Tropicale, UR7292 Dynamique des Interactions Hôte Pathogène, Fédération de Médecine Translationnelle, Université de Strasbourg, F-6700 Strasbourg, France
- Laboratoire de Parasitologie et Mycologie Médicale, Les Hôpitaux Universitaires de Strasbourg, F-6700 Strasbourg, France
| | - Carmen Costache
- Microbiology Department, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Cluj County Emergency Hospital, 400000 Cluj-Napoca, Romania
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Bidaud AL, Moreno-Sabater A, Normand AC, Cremer G, Foulet F, Brun S, Ayachi A, Imbert S, Chowdhary A, Dannaoui E. Evaluation of Gradient Concentration Strips for Detection of Terbinafine Resistance in Trichophyton spp. Antimicrob Agents Chemother 2023; 67:e0171622. [PMID: 37162356 PMCID: PMC10269145 DOI: 10.1128/aac.01716-22] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 04/14/2023] [Indexed: 05/11/2023] Open
Abstract
The number of dermatophytosis cases resistant to terbinafine is increasing all over the world. Therefore, there is a need for antifungal susceptibility testing of dermatophytes for better management of the patients. In the present study, we have evaluated a gradient test (GT) method for testing the susceptibility of dermatophytes to terbinafine. MIC values to terbinafine determined by the EUCAST reference technique and by gradient test were compared for 79 Trichophyton spp. isolates. Overall, MICs were lower with gradient test (MIC50 of 0.002 μg/mL) than with EUCAST (MIC50 of 0.016 μg/mL). Good categorical agreement (>90%) between the 2 techniques was obtained but the essential agreement was variable depending on the batch of gradient test.
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Affiliation(s)
- Anne-Laure Bidaud
- Unité de Parasitologie-Mycologie, Service de Microbiologie, Hôpital Européen Georges-Pompidou, AP-HP, Paris, France
- Faculté de Médecine, Université Paris Cité, Paris, France
| | - Alicia Moreno-Sabater
- Service de Parasitologie-Mycologie, Hôpital Saint-Antoine, AP-HP, Paris, France
- Centre d'Immunologie et des Maladies Infectieuses, (CIMI-PARIS), Inserm U1135, Sorbonne Université, Paris, France
| | - Anne-Cécile Normand
- Service de Parasitologie-Mycologie, Hôpital La Pitié-Salpêtrière, AP-HP, Paris, France
| | | | - Françoise Foulet
- Service de Parasitologie-Mycologie, Hôpitaux Universitaires Henri Mondor, AP-HP, Créteil, France
- EA 7380 Dynamic, UPEC, EnvA, USC ANSES, Faculté de Santé, Créteil, France
| | - Sophie Brun
- Service de Parasitologie-Mycologie, Hôpital Avicenne, AP-HP, Bobigny, France
- Faculté de Médecine, Université Sorbonne Paris Nord, Bobigny, France
| | - Aymen Ayachi
- Service de Parasitologie-Mycologie, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
| | - Sébastien Imbert
- Service de Parasitologie-Mycologie, CHU Bordeaux, Bordeaux, France
| | - Anuradha Chowdhary
- Medical Mycology Unit, Department of Microbiology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
- National Reference Laboratory for Antimicrobial Resistance in Fungal Pathogens, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Eric Dannaoui
- Unité de Parasitologie-Mycologie, Service de Microbiologie, Hôpital Européen Georges-Pompidou, AP-HP, Paris, France
- Faculté de Médecine, Université Paris Cité, Paris, France
- EA 7380 Dynamic, UPEC, EnvA, USC ANSES, Faculté de Santé, Créteil, France
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9
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Rapid back flushed direct sample injection bio-analytical HPLC-UV method for therapeutic drug monitoring of terbinafine. Anal Biochem 2022; 659:114951. [PMID: 36244510 DOI: 10.1016/j.ab.2022.114951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 10/02/2022] [Accepted: 10/06/2022] [Indexed: 12/14/2022]
Abstract
A rapid back flushed (BF) direct sample injection (DSI) high-performance liquid chromatography (HPLC) with UV detection (BF-DSI-HPLC-UV) has been developed to determine terbinafine (TERB) in human serum. For online solid phase extraction step, an isocratic mobile phase of phosphate buffer saline (pH 7.4) at 1 mL/min and a short protein-coated ODS column (PC-ODS-column) were used for the purification and enrichment of TERB. Two different chromatographic modes of PC-ODS-column were simultaneously operated. Macromolecular proteins were extracted by size-exclusion liquid chromatography, while TERB trapping and enrichment were achieved through reversed-phase liquid chromatography. The clear fraction containing TERB was transferred from the PC-ODS-column by BF mode onto the quantification step through a high pressure switching valve. An analytical mobile phase consisting of 80% methanol and 1% triethylamine in distilled deionized water (pH) 6 at 1 mL/min was used for the final separation on an ODS analytical column. TERB was quantified and detected by UV-detector at 224 nm. The proposed method showed high correlation coefficient (>0.999) over the concentrations range 4-1600 ng/mL with recoveries ranging from 98.48 to 93.86%. Measurement of TERB concentration in serum after administration of a single dose of 250 mg oral tablet was used to evaluate the applicability of the BF-DSI-HPLC-UV for pharmacokinetic study.
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10
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Cerreta AJ, Reinhart JM, Forsythe LR, O'Connor MR, Tang KN, Cox S, Keller KA. Bioencapsulation is a feasible method of terbinafine administration in Emydomyces testavorans-infected western pond turtles (Actinemys marmorata). Am J Vet Res 2022; 84:ajvr.22.08.0138. [PMID: 36469441 DOI: 10.2460/ajvr.22.08.0138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate the pharmacokinetics of terbinafine administered to western pond turtles (Actinemys marmorata) via oral gavage and bioencapsulated in earthworms. ANIMALS 7 western pond turtles. PROCEDURES A randomized complete crossover single-dose pharmacokinetic study was performed. Compounded terbinafine (25 mg/mL; 30 mg/kg) was administered through oral gavage (OG) directly into the stomach or bioencapsulated (BEC) into an earthworm vehicle. Blood (0.2 mL) was drawn from the jugular vein at 0, 0.5, 1, 2, 4, 8, 12, 24, 48, 72, and 120 hours after administration. Plasma terbinafine levels were measured using high-performance liquid chromatography. RESULTS Peak plasma terbinafine concentrations of 786.9 ± 911 ng/mL and 1,022.2 ± 911 were measured at 1.8 ± 2.8 and 14.1 ± 12.3 hours after OG and BEC administration, respectively. There was a significant (P = .031) increase in area under the curve with BEC compared to OG. Using steady-state predictions, with once-daily terbinafine administration, 3/7 and 7/7 turtles had plasma concentrations persistently greater than the minimum inhibitory concentration (MIC) for Emydomyces testavorans for the OG and BEC administration routes of administration, respectively. With administration every 48 hours, 3/7 turtles for the OG phase and 6/7 turtles for the BEC phase had concentrations greater than the E. testavorans MIC throughout the entire dosing interval. CLINICAL RELEVANCE Administration of terbinafine (30 mg/kg) every 24 or 48 hours via earthworm bioencapsulation in western pond turtles may be appropriate for the treatment of shell lesions caused by E. testavorans. Clinical studies are needed to assess the efficacy of treatment.
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Affiliation(s)
- Anthony J Cerreta
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois at Champaign-Urbana, Urbana, IL
| | - Jennifer M Reinhart
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois at Champaign-Urbana, Urbana, IL
| | - Lauren R Forsythe
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois at Champaign-Urbana, Urbana, IL
| | - Matthew R O'Connor
- A. Watson Armour III Center for Animal Health and Welfare, John G. Shedd Aquarium, Chicago, IL
| | - Karisa N Tang
- A. Watson Armour III Center for Animal Health and Welfare, John G. Shedd Aquarium, Chicago, IL
| | - Sherry Cox
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN
| | - Krista A Keller
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois at Champaign-Urbana, Urbana, IL
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Sukanan P, Suparp B, Yongsiri S, Chansiripornchai P, Kesdangsakonwut S. Successful management of colonic pythiosis in two dogs in Thailand using antifungal therapy. Vet Med Sci 2022; 8:2283-2291. [PMID: 36173734 PMCID: PMC9677377 DOI: 10.1002/vms3.955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2023] Open
Abstract
Gastrointestinal pythiosis is a severe, progressive and often a fatal disease, which is caused by the aquatic pathogen Pythium insidiosum. Treatment is challenging due to the disease's resistance to antifungal drugs. Surgical resection is frequently attempted in cases of pythiosis; however, it can be technically challenging. This report presents two dogs with decreased appetite, abdominal pain, progressive haematochezia, tenesmus and significant weight loss. With the medical histories of both being young canines, living in areas with access to natural water resources and with the main chronic gastrointestinal symptoms having not responded to symptomatic treatment, pythiosis was taken into consideration. Abdominal ultrasound revealed severe, diffuse thickening and loss of normal layering of the colonic wall. These findings led to a differential diagnosis between intestinal neoplasia and fungal disease. Full-thickness biopsies were later performed, and immunohistochemistry staining was suggested for colonic pythiosis. Medical treatment for pythiosis was successful with a combination of oral terbinafine and prednisolone. However, therapy with itraconazole in case 1 did not improve the clinical signs, and in case 2, itraconazole was used after all clinical signs have improved for clinical control. Since then, there has been no recurrence of clinical signs until the time of preparing this report (19 months for case 1, 11 months for case 2 since the cessation of treatment). The treatment was successful based on clinical signs and ultrasonographic data, and the disease remission was not confirmed by advance imaging, monitoring of pythiosis enzyme-linked immunosorbent essay concentration or repeat sampling.
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Affiliation(s)
| | | | | | - Piyarat Chansiripornchai
- Department of Veterinary Pharmacology, Faculty of Veterinary ScienceChulalongkorn UniversityBangkokThailand
| | - Sawang Kesdangsakonwut
- Department of Pathology, Faculty of Veterinary ScienceChulalongkorn UniversityBangkokThailand
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12
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Wal P, Saraswat N, Vig H. A detailed insight on the molecular and cellular mechanism of action of the antifungal drugs used in the treatment of superficial fungal infections. CURRENT DRUG THERAPY 2022. [DOI: 10.2174/1574885517666220328141054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Dermatomycosis, a type of fungal infection that can infect human skin, hair, and nails; day by day the growth of fungal infections ranging from superficial to systemic infection is alarming. Common causative agents included are Candida, Cryptococcus, Aspergillus, and Pneumocystis species.
Objective:
The effective treatment of the fungal infection includes the use of proper antifungal drug therapy. Antifungal drugs are classified into various classes. This paper focuses on understanding and interpreting the detailed molecular and cellular mechanism of action of various classes of an anti-fungal drug along with their important characteristics along with the safety and efficacy data of individual drugs of the particular class.
Methods:
The data selection for carrying out the respective study has been done by studying the combination of review articles and research papers from different databases like Research Gate, PubMed, MDPI, Elsevier, Science Direct, and Med Crave ranging from the year 1972 to 2019 by using the keywords like “anti-fungal agents”, “dermatophytes”, “cutaneous candidiasis”, “superficial fungal infections”, “oral candidiasis”, “amphotericin”, “echinocandins”, “azoles”, “polyenes” “ketoconazole”, “terbinafine”, “griseofulvin”, “azoles”.
Result:
Based on interpretation, we have concluded that the different classes of antifungal drugs follow the different mechanisms of action and target the fungal cell membrane, and are efficient in reducing fungal disease by their respective mechanism.
Conclusion:
The prevention and cure of fungal infections can be done by oral or topical antifungal drugs that aim to destroy the fungal cell membrane. These drugs show action by their respective pathways that are either preventing the formation of ergosterol or squalene or act by inhibiting β-1,3-glucan synthase enzyme. All the drugs are effective in treating fungal infections.
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Affiliation(s)
- Pranay Wal
- Dean & Professor, Institute of Pharmacy, Pranveer Singh Institute of Technology, Kanpur, India
| | - Nikita Saraswat
- Assistant Professor, Institute of Pharmacy, Pranveer Singh Institute of Technology, Kanpur, India
| | - Himangi Vig
- Research Scholar, Institute of Pharmacy, Pranveer Singh Institute of Technology, Kanpur, India
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Muñoz Declara S, Agnetti F, Roccabianca P, Squassino C, Porporato F, Zanna G. Mucocutaneous and cutaneous generalized candidiasis in a thymectomized dog. Med Mycol Case Rep 2022; 35:39-42. [PMID: 35106278 PMCID: PMC8789510 DOI: 10.1016/j.mmcr.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 12/20/2021] [Accepted: 01/13/2022] [Indexed: 10/29/2022] Open
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Tse C, Boodman C, Wuerz T. Trichosporon mucoides prosthetic valve endocarditis managed with antifungal suppression therapy. Med Mycol Case Rep 2022; 36:10-12. [PMID: 35242509 PMCID: PMC8881683 DOI: 10.1016/j.mmcr.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 12/04/2022] Open
Abstract
A 63-year-old male with mechanical aortic valve replacement presents with Trichosporon mucoides endocarditis. Eosinophilia was noted, which has recently been described in invasive trichosporonosis. He was treated successfully with combination voriconazole and terbinafine therapy. He was deemed not to be a cardiac surgery candidate, due to excessive estimated procedural mortality. Trichosporon is a ubiquitous yeast that can cause invasive disease in humans. Medical management of fungal endocarditis is reasonable if patient cannot go for surgery. Voriconazole and terbinafine can be used in Trichosporon infections with good clinical response. Eosinophils may be a non-specific marker of therapeutic response in T. mucoides infections.
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Affiliation(s)
- Carmen Tse
- Corresponding author.173 Notre Dame St. R2H 0C2, Winnipeg, Manitoba, Canada.
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15
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Antimicrobials and Resistance Part II: Antifungals, Antivirals, and Antiparasitics. J Am Acad Dermatol 2022; 86:1207-1226. [DOI: 10.1016/j.jaad.2021.11.065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 11/27/2021] [Accepted: 11/29/2021] [Indexed: 11/18/2022]
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16
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McEntire MS, Reinhart JM, Cox SK, Keller KA. Single-dose pharmacokinetics of orally administered terbinafine in bearded dragons (Pogona vitticeps) and the antifungal susceptibility patterns of Nannizziopsis guarroi. Am J Vet Res 2021; 83:256-263. [PMID: 34941564 DOI: 10.2460/ajvr.21.02.0023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To identify the antifungal susceptibility of Nanniziopsis guarroi isolates and to evaluate the single-dose pharmacokinetics of orally administered terbinafine in bearded dragons. ANIMALS 8 healthy adult bearded dragons. PROCEDURES 4 isolates of N guarroi were tested for antifungal susceptibility. A compounded oral solution of terbinafine (25 mg/mL [20 mg/kg]) was given before blood (0.2 mL) was drawn from the ventral tail vein at 0, 4, 8, 12, 24, 48, 72, and 96 hours after administration. Plasma terbinafine concentrations were measured with high-performance liquid chromatography. RESULTS The antifungal minimum inhibitory concentrations against N guarroi isolates ranged from 4,000 to > 64,000 ng/mL for fluconazole, 125 to 2,000 ng/mL for itraconazole, 125 to 2,000 ng/mL for ketoconazole, 125 to 1,000 ng/mL for posaconazole, 60 to 250 ng/mL for voriconazole, and 15 to 30 ng/mL for terbinafine. The mean ± SD peak plasma terbinafine concentration in bearded dragons was 435 ± 338 ng/mL at 13 ± 4.66 hours after administration. Plasma concentrations remained > 30 ng/mL for > 24 hours in all bearded dragons and for > 48 hours in 6 of 8 bearded dragons. Mean ± SD terminal half-life following oral administration was 21.2 ± 12.40 hours. CLINICAL RELEVANCE Antifungal susceptibility data are available for use in clinical decision making. Results indicated that administration of terbinafine (20 mg/kg, PO, q 24 to 48 h) in bearded dragons may be appropriate for the treatment of dermatomycoses caused by N guarroi. Clinical studies are needed to determine the efficacy of such treatment.
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Affiliation(s)
- Michael S McEntire
- 1Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois at Champaign-Urbana, Urbana, IL
| | - Jennifer M Reinhart
- 1Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois at Champaign-Urbana, Urbana, IL
| | - Sherry K Cox
- 2Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN
| | - Krista A Keller
- 1Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois at Champaign-Urbana, Urbana, IL
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17
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Pervaiz F, Mushtaq R, Noreen S. Formulation and optimization of terbinafine HCl loaded chitosan/xanthan gum nanoparticles containing gel: Ex-vivo permeation and in-vivo antifungal studies. J Drug Deliv Sci Technol 2021. [DOI: 10.1016/j.jddst.2021.102935] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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18
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Nikitina LE, Lisovskaya SA, Startseva VA, Frolova LL, Kutchin AV, Shevchenko OG, Ostolopovskaya OV, Pavelyev RS, Khelkhal MA, Gilfanov IR, Fedyunina IV, Khaliullin RR, Akhverdiev RF, Gerasimov AV, Abzaldinova EV, Izmailov AG. Biological Activity of Bicyclic Monoterpene Alcohols. BIONANOSCIENCE 2021. [DOI: 10.1007/s12668-021-00912-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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19
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In vitro antifungal combination of terbinafine with itraconazole against isolates of Trichophyton spp. Antimicrob Agents Chemother 2021; 66:e0144921. [PMID: 34633845 DOI: 10.1128/aac.01449-21] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Terbinafine is used as first-line therapy for dermatophytosis, but the incidence of terbinafine-resistance is increasing. Combination of terbinafine with itraconazole was tested by checkerboard based on the EUCAST methodology for antifungal susceptibility testing against 9 terbinafine-susceptible and 7 terbinafine-resistant clinical isolates of Trichophyton spp. from India. Synergistic interactions were observed for 4/9 of the susceptible isolates with fractional inhibitory concentration index (FICI) values of 0.3125 to 0.5 and for 4/7 of the resistant isolates with FICI values of 0.032 to 0.3125.
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20
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TERBINAFINE PHARMACOKINETICS FOLLOWING SINGLE-DOSE ORAL ADMINISTRATION IN RED-EARED SLIDER TURTLES ( TRACHEMYS SCRIPTA ELEGANS): A PILOT STUDY. J Zoo Wildl Med 2021; 52:520-528. [PMID: 34130394 DOI: 10.1638/2020-0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 11/21/2022] Open
Abstract
In this pilot study, the pharmacokinetics of terbinafine were determined in six apparently healthy red-eared slider turtles (Trachemys scripta elegans) after a single PO administration. Terbinafine suspension (15 mg/kg, once) was administered via gavage tube to all turtles. Blood samples were collected immediately before (time 0) and at 1, 2, 4, 8, 24, and 48 h after drug administration. Plasma terbinafine concentrations were quantified by ultra-performance liquid chromatography-mass spectrometry, and noncompartmental pharmacokinetic analysis was performed. None of the animals showed any adverse responses following terbinafine administration. Mean area under the curve from time 0 to 24 h was 1,213 h × ng/ml (range 319-7,309), mean peak plasma concentration was 201.5 ng/ml (range 45.8-585.3), mean time to maximum plasma concentration was 1.26 h (range 1-4), mean residence time was 7.71 h (range 3.85-14.8), and mean terminal half-life was 5.35 h (range 2.67-9.83). The administration of terbinafine (15 mg/kg, PO) may be appropriate for treatment of select fungal organisms with low minimum inhibitory concentrations in red-eared slider turtles but may require q12h administration even for organisms with low minimum inhibitory concentrations. Multiple-dose studies as well as clinical studies are needed to determine ideal dosages and efficacy.
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21
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Corallo CE, Ivulich SP, Kotecha DS, Morrissey O. Dementia-Like Symptoms Associated With Posaconazole. J Pharm Pract 2020; 35:135-139. [PMID: 33084474 DOI: 10.1177/0897190020958235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Posaconazole is widely used in lung transplant recipients as pre-emptive therapy or universal fungal prophylaxis. In this patient group, posaconazole is increasingly used instead of voriconazole due to the concerns of an increased risk of squamous cell carcinoma (SCC) with voriconazole, particularly with its long-term use. Dose dependent toxicity has not been identified for posaconazole in the registration trials of intravenous (IV) and modified-release tablet formulations. This is supported by post-marketing experience. We describe a lung transplant recipient who experienced dementia-like symptoms almost 3 years after commencing posaconazole for treatment of Aspergillus fumigatus complex and Lomentospora prolificans (formerly Scedosporium prolificans) fungal infections. Symptoms resolved upon discontinuation of posaconazole, but recurred when re-challenged at a lower dose more than a year later. To the best of our knowledge, this is the first case reporting a dementia-like state with posaconazole.
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Affiliation(s)
| | | | - Dr Sakhee Kotecha
- Department of Allergy, Immunology & Respiratory Medicine, The Alfred, Melbourne, Victoria, Australia
| | - Orla Morrissey
- Department of Infectious Diseases, Alfred Health, Melbourne, Victoria, Australia
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22
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Garipov MR, Sabirova AE, Pavelyev RS, Shtyrlin NV, Lisovskaya SA, Bondar OV, Laikov AV, Romanova JG, Bogachev MI, Kayumov AR, Shtyrlin YG. Targeting pathogenic fungi, bacteria and fungal-bacterial biofilms by newly synthesized quaternary ammonium derivative of pyridoxine and terbinafine with dual action profile. Bioorg Chem 2020; 104:104306. [PMID: 33011535 DOI: 10.1016/j.bioorg.2020.104306] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 09/18/2020] [Accepted: 09/20/2020] [Indexed: 01/29/2023]
Abstract
Many pathogenic bacteria and microscopic fungi form rigid polymicrobial biofilms this way enhancing their resistant to treatment. A series of novel pyridoxine-based quaternary ammonium derivatives of terbinafine characterized by both antifungal and antibacterial activities was designed. The leading compound named KFU-127 exhibits promising antifungal and antibacterial activities against various bacteria and micromycetes in both planktonic and biofilm-embedded forms demonstrating MIC values comparable with those of conventional antifungals and antimicrobials. Similar to other antiseptics like benzalkonium chloride and miramistin, KFU-127 is considerably toxic for eukaryotic cells that limits is application to topical treatment options. On the other hand, KFU-127 reduces the number of viable biofilm-embedded bacteria and C. albicans by 3 orders of magnitude at concentrations 2-4 times lower than those of reference drugs and successfully eradicates S. aureus-C. albicans mixed biofilms. The mechanism of antimicrobial action of KFU-127 is bimodal including both membrane integrity damage and pyridoxal-dependent enzymes targeting. We expect that this bilateral mechanism would result in lower rates of resistance development in both fungal and bacterial pathogens. Taken together, our data suggest KFU-127 as a new promising broad spectrum topical antimicrobial capable of one-shot targeting of bacterial and fungal-bacterial biofilms.
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Affiliation(s)
- Marsel R Garipov
- Kazan Federal University, 18 Kremlevskaya str, 420008 Kazan, Russian Federation
| | - Alina E Sabirova
- Kazan Federal University, 18 Kremlevskaya str, 420008 Kazan, Russian Federation
| | - Roman S Pavelyev
- Kazan Federal University, 18 Kremlevskaya str, 420008 Kazan, Russian Federation
| | - Nikita V Shtyrlin
- Kazan Federal University, 18 Kremlevskaya str, 420008 Kazan, Russian Federation
| | - Svetlana A Lisovskaya
- Kazan Scientific Research Institute of Epidemiology and Microbiology, 67 Bolshaya Krasnaya str, 420015 Kazan, Russian Federation; Kazan State Medical University
| | - Oksana V Bondar
- Kazan Federal University, 18 Kremlevskaya str, 420008 Kazan, Russian Federation
| | - Aleksandr V Laikov
- Kazan Federal University, 18 Kremlevskaya str, 420008 Kazan, Russian Federation
| | - Julia G Romanova
- Kazan Federal University, 18 Kremlevskaya str, 420008 Kazan, Russian Federation
| | - Mikhail I Bogachev
- St Petersburg Electrotechnical University, 5 Professor Popov str., 197376 St. Petersburg, Russian Federation
| | - Airat R Kayumov
- Kazan Federal University, 18 Kremlevskaya str, 420008 Kazan, Russian Federation.
| | - Yurii G Shtyrlin
- Kazan Federal University, 18 Kremlevskaya str, 420008 Kazan, Russian Federation.
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Vikas A, Rashmin P, Mrunali P, Chavan RB, Kaushik T. Mechanistic Insights of Formulation Approaches for the Treatment of Nail Infection: Conventional and Novel Drug Delivery Approaches. AAPS PharmSciTech 2020; 21:67. [PMID: 31938980 DOI: 10.1208/s12249-019-1591-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 11/25/2019] [Indexed: 02/07/2023] Open
Abstract
Onychomycosis is a chronic disorder that is difficult to manage and hard to eradicate with perilous trends to relapse. Due to increased prevalence of HIV, use of immunosuppressant drugs and lifestyle-related factors, population affected with fungal infection of nail (Onychomycosis) happens to increase extensively in last two decades. Modalities available for the treatment of onychomycosis include systemically administered antifungals, mechanical procedures, and topical drug therapy. But the efficacy of the most of approaches to deliver drug at targeted site, i.e., deep-seated infected nail bed is limited due to compact and highly keratinized nail structure. A series of advanced formulation approaches, such as transfersomes, liposomes, nano/micro emulsion, nail lacquers etc., have been attempted to improve the drug penetration into nail plate more efficiently. The manuscript reviews these formulation approaches with their possible mechanisms by which they improve the drug penetration.Comparative analysis of available treatment modalities for onychomycosis has been provided with pros and cons of each alternatives. Additionally, ongoing research about the application of biological materials such as modified cationic antimicrobial peptides (AMPs), plant-derived proteins, and synthetic antimicrobial peptidomimetics have also been explored.
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Alkeswani A, Cantrell W, Elewski B. Treatment of Tinea Capitis. Skin Appendage Disord 2019; 5:201-210. [PMCID: PMC6615323 DOI: 10.1159/000495909] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 11/29/2018] [Indexed: 11/26/2023] Open
Abstract
Tinea capitis is a common fungal infection of the hair of the scalp affecting predominately prepubertal children. In the US, griseofulvin has been considered a first-line therapy agent for tinea capitis since the 1960s. However, it has been falling out of favor due to significant treatment failure, high cost, and long duration of treatment. Other antifungal agents have been researched as an alternative to griseofulvin. This paper will review the relevant pharmacologic properties, dosing, cost, efficacy, and adverse events profile for griseofulvin, terbinafine, itraconazole, fluconazole, and some adjuvant therapy options such as selenium sulfide shampoos and topical ketoconazole.
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Affiliation(s)
- Amena Alkeswani
- University of Alabama Birmingham, School of Medicine, Birmingham, Alabama, USA
| | - Wendy Cantrell
- UAB Department of Dermatology, Dermatology at the Whitaker Clinic, Birmingham, Alabama, USA
| | - Boni Elewski
- University of Alabama Birmingham, Department of Dermatology, Birmingham, Alabama, USA
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Sun L, Wan Z, Li R, Yu J. In vitro activities of six antifungal agents and their combinations against Chaetomium spp. J Med Microbiol 2019; 68:1042-1046. [PMID: 31140972 DOI: 10.1099/jmm.0.001004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To assess in vitro activities of six antifungal agents (amphotericin B, itraconazole, voriconazole, posaconazole, caspofungin and terbinafine) and the combined effects of eight pairs of them (caspofungin or terbinafine with amphotericin B, itraconazole, voriconazole or posaconazole) against 22 isolates of Chaetomium spp. METHODOLOGY The broth microdilution method drafted by the Clinical and Laboratory Standards Institute and the checkerboard method were used in this study to evaluate in vitro activities of antifungal drugs both alone and in combination against Chaetomium spp. RESULTS Amphotericin B and triazoles exhibited lower geometric mean, MIC50 and MIC90 than caspofungin and terbinafine. Besides, all the paired drugs displayed varying degrees of synergism, with the interactions between caspofungin and itraconazole ranking first (86.36 %). CONCLUSION Our study illustrated varying degrees of synergism between caspofungin or terbinafine and itraconazole, voriconazole, posaconazole or amphotericin B towards Chaetomium spp., which could be a reference for the clinical treatment of Chaetomium spp. infections.
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Affiliation(s)
- Lingyue Sun
- Research Center for Medical Mycology, Peking University; Department of Dermatology and Venereology, Peking University First Hospital; Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, PR China
| | - Zhe Wan
- Research Center for Medical Mycology, Peking University; Department of Dermatology and Venereology, Peking University First Hospital; Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, PR China
| | - Ruoyu Li
- Research Center for Medical Mycology, Peking University; Department of Dermatology and Venereology, Peking University First Hospital; Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, PR China
| | - Jin Yu
- Research Center for Medical Mycology, Peking University; Department of Dermatology and Venereology, Peking University First Hospital; Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, PR China
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Bhadoriya A, Shah PA, Shrivastav PS, Bharwad KD, Singhal P. Determination of terbinafine in human plasma using UPLC-MS/MS: Application to a bioequivalence study in healthy subjects. Biomed Chromatogr 2019; 33:e4543. [PMID: 30933360 DOI: 10.1002/bmc.4543] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 03/11/2019] [Accepted: 03/26/2019] [Indexed: 11/08/2022]
Abstract
A high-throughput and sensitive ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method has been developed for the determination of terbinafine in human plasma. The method employed liquid-liquid extraction of terbinafine and terbinafine-d7 (used as internal standard) from 100 μL human plasma with ethyl acetate-n-hexane (80:20, v/v) solvent mixture. Chromatography was performed on a BEH C18 (50 × 2.1 mm, 1.7 μm) column using acetonitrile-8.0 mm ammonium formate, pH 3.5 (85:15, v/v) under isocratic elution. For quantitative analysis, MS/MS ion transitions were monitored at m/z 292.2/141.1 and m/z 299.1/148.2 for terbinafine and terbinafine-d7, respectively, using electrospray ionization in the positive mode. The method was validated according to regulatory guidance for selectivity, sensitivity, linearity, recovery, matrix effect, stability, dilution reliability and ruggedness with acceptable accuracy and precision. The method shows good linearity over the tested concentration range from 1.00 to 2000 ng/mL (r2 ≥ 0.9984). The intra-batch and inter-batch precision (CV) was 1.8-3.2 and 2.1-4.5%, respectively. The method was successfully applied to a bioequivalence study with 250 mg terbinafine in 32 healthy subjects. The major advantage of this method includes higher sensitivity, small plasma volume for processing and a short analysis time.
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Affiliation(s)
| | - Priyanka A Shah
- Department of Chemistry, School of Sciences, Gujarat University, Ahmedabad, 380009, India
| | - Pranav S Shrivastav
- Department of Chemistry, School of Sciences, Gujarat University, Ahmedabad, 380009, India
| | - Kirtikumar D Bharwad
- Department of Chemistry, School of Sciences, Gujarat University, Ahmedabad, 380009, India
| | - Puran Singhal
- Bioanalytical Department, Alkem Laboratories Ltd., Lower Parel, Mumbai, 400013, India
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McAtee BB, Cummings KJ, Cook AK, Lidbury JA, Heseltine JC, Willard MD. Opportunistic Invasive Cutaneous Fungal Infections Associated with Administration of Cyclosporine to Dogs with Immune-mediated Disease. J Vet Intern Med 2017; 31:1724-1729. [PMID: 28887897 PMCID: PMC5697195 DOI: 10.1111/jvim.14824] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 06/29/2017] [Accepted: 08/03/2017] [Indexed: 02/05/2023] Open
Abstract
Background Opportunistic invasive fungal infections (OIFIs) occur in dogs administered immunosuppressive medications. However, the epidemiology of OIFIs among dogs undergoing immunosuppressive treatment is poorly understood. The aims of this study were to (1) estimate the incidence of OIFIs among dogs diagnosed with certain immune‐mediated diseases and treated with immunosuppressive drugs, and (2) determine if administration of particular drug(s) was a risk factor for OIFIs. Hypothesis Dogs receiving cyclosporine treatment (alone or as part of a multidrug protocol) are at higher risk of developing OIFIs. Animals One hundred and thirteen client‐owned dogs diagnosed with select immune‐mediated diseases: 42 with IMHA, 29 with ITP, 34 with IMPA, and 8 with Evans syndrome. Methods Retrospective cohort study. Medical records of dogs presenting to the Texas A&M University, Veterinary Medical Teaching Hospital between January 2008 and December 2015, and treated for 1 or more of IMHA, IMPA, ITP, or Evans syndrome were retrospectively reviewed. Dogs that did not develop an OIFI were excluded if they died, were euthanized, or were lost to follow‐up within 120 days of initiation of immunosuppressive treatment. Results Fifteen dogs of 113 (13%) were diagnosed with an OIFI based on 1 or more of cytology, culture, or histopathology. The odds of developing an OIFI were greater among dogs that were treated with cyclosporine (OR = 7.1, P = 0.017; 95% CI, 1.5–34.4) and among male dogs (OR = 5.1, P = 0.018; 95% CI, 1.4–17.9). Conclusions and Clinical Importance OIFIs were significantly more likely in male dogs and those receiving cyclosporine. It is important to consider OIFIs as a potential complication of immunosuppressive treatment, particularly cyclosporine.
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Affiliation(s)
- B B McAtee
- Texas A&M University, College Station, TX
| | | | - A K Cook
- Texas A&M University, College Station, TX
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28
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Mayser P. [Terbinafine : Drug-induced lupus erythematodes and triggering of psoriatic skin lesions]. Hautarzt 2017; 67:724-31. [PMID: 27455869 DOI: 10.1007/s00105-016-3844-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Based on the technical information that oral terbinafine must be used with caution in patients with pre-existing psoriasis or lupus erythematosus, the literature was summarized. Terbinafine belongs to the drugs able to induce subcutaneous lupus erythematosus (SCLE)-with a relatively high risk. The clinical picture of terbinafine-induced SCLE may be highly variable and can also include erythema exsudativum multiforme-like or bullous lesions. Thus, differentiation of terbinafine-induced Stevens-Johnson syndrome or toxic epidermal necrolysis may be difficult. Therefore, terbinafine should be prescribed with caution in patients who show light sensitivity, arthralgias, positive antinuclear antibodies or have a history of SLE or SCLE. Case reports include wide-spread, but mostly nonlife-threatening courses, which did not require systemic therapy with steroids or antimalarials in every case. Terbinafine is also able to induce or to aggravate psoriasis. The latency period seems to be rather short (<4 weeks). Terbinafine therefore is not first choice if a systemic therapy with antimycotics is indicated in a patient with psoriasis or psoriatic diathesis. Azole derivatives according to the guidelines may be used as an alternative.
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Affiliation(s)
- P Mayser
- , Hofmannstr. 11, 35444, Biebertal, Deutschland.
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29
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Kane LP, Allender MC, Archer G, Leister K, Rzadkowska M, Boers K, Souza M, Cox S. Pharmacokinetics of nebulized and subcutaneously implanted terbinafine in cottonmouths (Agkistrodon piscivorus
). J Vet Pharmacol Ther 2017; 40:575-579. [DOI: 10.1111/jvp.12406] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 02/23/2017] [Indexed: 11/30/2022]
Affiliation(s)
- L. P. Kane
- Wildlife Epidemiology Lab; Department of Comparative Biosciences; College of Veterinary Medicine; University of Illinois; Urbana IL USA
| | - M. C. Allender
- Wildlife Epidemiology Lab; Department of Comparative Biosciences; College of Veterinary Medicine; University of Illinois; Urbana IL USA
| | - G. Archer
- Wildlife Epidemiology Lab; Department of Comparative Biosciences; College of Veterinary Medicine; University of Illinois; Urbana IL USA
| | - K. Leister
- Wildlife Epidemiology Lab; Department of Comparative Biosciences; College of Veterinary Medicine; University of Illinois; Urbana IL USA
| | - M. Rzadkowska
- Wildlife Epidemiology Lab; Department of Comparative Biosciences; College of Veterinary Medicine; University of Illinois; Urbana IL USA
| | - K. Boers
- Wildlife Epidemiology Lab; Department of Comparative Biosciences; College of Veterinary Medicine; University of Illinois; Urbana IL USA
| | - M. Souza
- Department of Biomedical and Diagnostic Sciences; University of Tennessee; Knoxville Tennessee USA
| | - S. Cox
- Department of Biomedical and Diagnostic Sciences; University of Tennessee; Knoxville Tennessee USA
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30
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Durdu M, Ilkit M, Tamadon Y, Tolooe A, Rafati H, Seyedmousavi S. Topical and systemic antifungals in dermatology practice. Expert Rev Clin Pharmacol 2016; 10:225-237. [DOI: 10.1080/17512433.2017.1263564] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Murat Durdu
- Department of Dermatology, Faculty of Medicine, Başkent University Adana Hospital, Adana, Turkey
| | - Macit Ilkit
- Division of Mycology, Department of Microbiology, Faculty of Medicine, University of Çukurova, Adana, Turkey
| | - Yalda Tamadon
- Department of Small Animal Internal Medicine, Faculty of Specialized Veterinary Sciences, Science and Research Branch, Islamic Azad University (IAU), Tehran, Iran
| | - Ali Tolooe
- Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Haleh Rafati
- Department of Biochemistry, Erasmus University Medical Center, the Netherlands
| | - Seyedmojtaba Seyedmousavi
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
- Invasive Fungi Research Center, Mazandaran University of Medical Sciences, Sari, Iran
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31
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Reichert-Lima F, Busso-Lopes AF, Lyra L, Peron IH, Taguchi H, Mikami Y, Kamei K, Moretti ML, Schreiber AZ. Evaluation of antifungal combination againstCryptococcusspp. Mycoses 2016; 59:585-93. [DOI: 10.1111/myc.12510] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 04/03/2016] [Accepted: 04/04/2016] [Indexed: 01/06/2023]
Affiliation(s)
- Franqueline Reichert-Lima
- Clinical Pathology Department; Faculty of Medical Sciences; State University of Campinas; Campinas Sao Paulo Brazil
| | - Ariane F. Busso-Lopes
- Internal Medicine Department; Faculty of Medical Sciences; State University of Campinas; Campinas Sao Paulo Brazil
| | - Luzia Lyra
- Clinical Pathology Department; Faculty of Medical Sciences; State University of Campinas; Campinas Sao Paulo Brazil
| | - Isabela Haddad Peron
- Clinical Pathology Department; Faculty of Medical Sciences; State University of Campinas; Campinas Sao Paulo Brazil
| | - Hideaki Taguchi
- Medical Mycology Research Center; Chiba University; Chiba Japan
| | - Yuzuru Mikami
- Medical Mycology Research Center; Chiba University; Chiba Japan
| | - Katsuiko Kamei
- Medical Mycology Research Center; Chiba University; Chiba Japan
| | - Maria Luiza Moretti
- Internal Medicine Department; Faculty of Medical Sciences; State University of Campinas; Campinas Sao Paulo Brazil
| | - Angelica Z. Schreiber
- Clinical Pathology Department; Faculty of Medical Sciences; State University of Campinas; Campinas Sao Paulo Brazil
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32
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Adriaenssens N, Uka V, Versporten A, Bolokhovets G, Ghazaryan L, Abilova V, Pyshnik G, Spasojevic T, Korinteli I, Kambaralieva B, Cizmovic L, Carp A, Radonjic V, Maqsudova N, Alkan A, Coenen S, Pedersen HB, Sautenkova N, Goossens H. Systemic antimycotic and antifungal use in eastern Europe: a cross-national database study in coordination with the WHO Regional Office for Europe. J Antimicrob Chemother 2015; 70:2173-5. [PMID: 25802285 DOI: 10.1093/jac/dkv064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Niels Adriaenssens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium Centre for General Practice, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Valdet Uka
- Department of Pharmacy, Faculty of Medicine, University of Prishtina, Prishtina, Kosovo
| | - Ann Versporten
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Ganna Bolokhovets
- Health Technologies and Pharmaceuticals, Division of Health Systems and Public Health, WHO Regional Office for Europe, Copenhagen, Denmark
| | - Lilit Ghazaryan
- Scientific Centre of Drug and Medical Technology Expertise of the Ministry of Health, Yerevan, Armenia
| | - Vafa Abilova
- Ministry of Health of Azerbaijan Republic, Analytical Expertise Centre for Medicines, Baku, Azerbaijan
| | - Galina Pyshnik
- Department on Organization of Medicines Provision, Ministry of Health, Minsk, Republic of Belarus
| | - Tijana Spasojevic
- Agency for Medicines and Medical Devices of Bosnia and Herzegovina, Banja Luka, Bosnia and Herzegovina
| | | | | | - Lidija Cizmovic
- Agency for Medicines and Medical Devices of Montenegro, Podgorica, Montenegro
| | - Angela Carp
- Agency of Medicines, Chisinau, Republic of Moldova
| | - Vesela Radonjic
- Medicines and Medical Devices Agency of Serbia, Belgrade, Serbia
| | | | - Ali Alkan
- Ministry of Health of Turkey, Turkish Medicines and Medical Devices Agency, Ankara, Turkey
| | - Samuel Coenen
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium Centre for General Practice, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Hanne Bak Pedersen
- Health Technologies and Pharmaceuticals, Division of Health Systems and Public Health, WHO Regional Office for Europe, Copenhagen, Denmark
| | - Nina Sautenkova
- Health Technologies and Pharmaceuticals, Division of Health Systems and Public Health, WHO Regional Office for Europe, Copenhagen, Denmark
| | - Herman Goossens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
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33
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Greenblatt HK, Greenblatt DJ. Liver injury associated with ketoconazole: review of the published evidence. J Clin Pharmacol 2014; 54:1321-9. [PMID: 25216238 DOI: 10.1002/jcph.400] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 09/09/2014] [Indexed: 12/18/2022]
Abstract
The azole antifungal agent ketoconazole has been available since 1981 for the treatment of fungal infections. In 2013, the American Food and Drug Administration and the European Medicines Agency issued warnings or prohibitions against the clinical use of oral ketoconazole due to the risk of liver injury which may lead to liver transplantation or death. From the available published evidence it is difficult to determine the actual incidence or prevalence of liver injury during clinical use of ketoconazole as an antifungal. Hepatic injury, when it occurs, is generally evident as asymptomatic and reversible abnormalities of liver function tests. However, serious liver injury has been reported. Alternatives to ketoconazole (such as itraconazole, fluconazole, voriconazole, and terbinafine) are available, but improved safety with respect to liver injury risk is not clearly established. We are not aware of published reports of significant ketoconazole-associated liver injury in volunteer study participants when ketoconazole has been used as a CYP3A inhibitor in the context of clinical research on drug metabolism. Possible alternatives to ketoconazole as prototype CYP3A inhibitors include ritonavir and potentially itraconazole, but not clarithromycin.
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Affiliation(s)
- H Karl Greenblatt
- Program in Pharmacology and Experimental Therapeutics, Tufts University School of Medicine and Tufts Medical Center, Boston, MA, USA
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34
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Neoh CF, Daniell M, Chen SCA, Stewart K, Kong DCM. Clinical utility of caspofungin eye drops in fungal keratitis. Int J Antimicrob Agents 2014; 44:96-104. [PMID: 24933448 DOI: 10.1016/j.ijantimicag.2014.04.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 04/04/2014] [Accepted: 04/04/2014] [Indexed: 11/29/2022]
Abstract
Treatment of fungal keratitis remains challenging. To date, only the polyenes and azoles are commonly used topically in the management of fungal keratitis. Natamycin, a polyene, is the only antifungal eye drop that is commercially available; the remainder are prepared in-house and are used in an 'off-label' manner. Failure of medical treatment for fungal keratitis is common, hence there is a need for more effective topical antifungal therapy. To increase the antifungal eye drop armamentarium, it is important to investigate the utility of other classes of antifungal agents for topical use. Caspofungin, an echinocandin antifungal agent, could potentially be used to address the existing shortcomings. However, little is known about the usefulness of topically administered caspofungin. This review will briefly explore the incidence, epidemiology and antifungal treatment of fungal keratitis. It will focus primarily on evidence related to the efficacy, safety and practicality of using caspofungin eye drops in fungal keratitis.
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Affiliation(s)
- Chin Fen Neoh
- Collaborative Drug Discovery Research (CDDR) Group, Faculty of Pharmacy, Universiti Teknologi MARA, 42300 Bandar Puncak Alam, Selangor, Malaysia; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University (Parkville Campus), 381 Royal Parade, Parkville, VIC 3052, Australia
| | - Mark Daniell
- Corneal Unit, Royal Victorian Eye and Ear Hospital (RVEEH), 32 Gisborne Street, East Melbourne, VIC 3002, Australia; Centre for Eye Research Australia, University of Melbourne, c/- RVEEH, Locked Bag 8, East Melbourne, VIC 3002, Australia
| | - Sharon C-A Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICMPR - Pathology West, Westmead Hospital, P.O. Box 533, Wentworthville, NSW 2145, Australia
| | - Kay Stewart
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University (Parkville Campus), 381 Royal Parade, Parkville, VIC 3052, Australia
| | - David C M Kong
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University (Parkville Campus), 381 Royal Parade, Parkville, VIC 3052, Australia.
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35
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Gallo-Ebert C, Donigan M, Stroke IL, Swanson RN, Manners MT, Francisco J, Toner G, Gallagher D, Huang CY, Gygax SE, Webb M, Nickels JT. Novel antifungal drug discovery based on targeting pathways regulating the fungus-conserved Upc2 transcription factor. Antimicrob Agents Chemother 2013; 58:258-66. [PMID: 24145546 PMCID: PMC3910738 DOI: 10.1128/aac.01677-13] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 10/16/2013] [Indexed: 01/05/2023] Open
Abstract
Infections by Candida albicans and related fungal pathogens pose a serious health problem for immunocompromised patients. Azole drugs, the most common agents used to combat infections, target the sterol biosynthetic pathway. Adaptation to azole therapy develops as drug-stressed cells compensate by upregulating several genes in the pathway, a process mediated in part by the Upc2 transcription factor. We have implemented a cell-based high-throughput screen to identify small-molecule inhibitors of Upc2-dependent induction of sterol gene expression in response to azole drug treatment. The assay is designed to identify not only Upc2 DNA binding inhibitors but also compounds impeding the activation of gene expression by Upc2. An AlphaScreen assay was developed to determine whether the compounds identified interact directly with Upc2 and inhibit DNA binding. Three compounds identified by the cell-based assay inhibited Upc2 protein level and UPC2-LacZ gene expression in response to a block in sterol biosynthesis. The compounds were growth inhibitory and attenuated antifungal-induced sterol gene expression in vivo. They did so by reducing the level of Upc2 protein and Upc2 DNA binding in the presence of drug. The mechanism by which the compounds restrict Upc2 DNA binding is not through a direct interaction, as demonstrated by a lack of DNA binding inhibitory activity using the AlphaScreen assay. Rather, they likely inhibit a novel pathway activating Upc2 in response to a block in sterol biosynthesis. We suggest that the compounds identified represent potential precursors for the synthesis of novel antifungal drugs.
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Affiliation(s)
- Christina Gallo-Ebert
- The Institute of Metabolic Disorders, Genesis Biotechnology Group, Hamilton, New Jersey, USA
| | - Melissa Donigan
- The Institute of Metabolic Disorders, Genesis Biotechnology Group, Hamilton, New Jersey, USA
| | - Ilana L. Stroke
- Venenum Biodesign, Genesis Biotechnology Group, Hamilton, New Jersey, USA
| | - Robert N. Swanson
- Venenum Biodesign, Genesis Biotechnology Group, Hamilton, New Jersey, USA
| | - Melissa T. Manners
- Venenum Biodesign, Genesis Biotechnology Group, Hamilton, New Jersey, USA
| | - Jamie Francisco
- The Institute of Metabolic Disorders, Genesis Biotechnology Group, Hamilton, New Jersey, USA
| | - Geoffrey Toner
- Femeris, Women's Health Research Center, Medical Diagnostic Laboratories, Genesis Biotechnology Group, Hamilton, New Jersey, USA
| | - Denise Gallagher
- Venenum Biodesign, Genesis Biotechnology Group, Hamilton, New Jersey, USA
| | - Chia-Yu Huang
- Venenum Biodesign, Genesis Biotechnology Group, Hamilton, New Jersey, USA
| | - Scott E. Gygax
- Femeris, Women's Health Research Center, Medical Diagnostic Laboratories, Genesis Biotechnology Group, Hamilton, New Jersey, USA
| | - Maria Webb
- Venenum Biodesign, Genesis Biotechnology Group, Hamilton, New Jersey, USA
| | - Joseph T. Nickels
- The Institute of Metabolic Disorders, Genesis Biotechnology Group, Hamilton, New Jersey, USA
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36
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Abstract
Combinations of terbinafine or caspofungin with amphotericin B, posaconazole, or itraconazole were studied as potential treatments against 18 isolates of Mucor irregularis in vitro. Synergism of the combinations of terbinafine with amphotericin B, posaconazole, and itraconazole against 38.9, 33.3, and 44.4% of the strains studied was observed. In contrast, synergism of the combinations of caspofungin with amphotericin B, posaconazole, and itraconazole against 99.4, 66.7, and 99.4% of the strains studied was observed. Furthermore, no antagonism was observed.
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In vitro antifungal susceptibility of clinically relevant species belonging to Aspergillus section Flavi. Antimicrob Agents Chemother 2013; 57:1944-7. [PMID: 23335742 DOI: 10.1128/aac.01902-12] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The in vitro antifungal susceptibility of 77 isolates belonging to different clinically relevant species of Aspergillus section Flavi, including those of different phylogenetic clades of A. flavus, was tested for nine antifungal agents using a microdilution reference method (CLSI, M38-A2). Terbinafine and the echinocandins demonstrated lower MICs/MECs for all species evaluated, followed by posaconazole. Amphotericin B showed MICs ≥ 2 μg/ml for 38 (49.4%) of the 77 isolates tested.
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Alcazar-Fuoli L, Mellado E. Ergosterol biosynthesis in Aspergillus fumigatus: its relevance as an antifungal target and role in antifungal drug resistance. Front Microbiol 2013; 3:439. [PMID: 23335918 PMCID: PMC3541703 DOI: 10.3389/fmicb.2012.00439] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 12/19/2012] [Indexed: 11/13/2022] Open
Abstract
Ergosterol, the major sterol of fungal membranes, is essential for developmental growth and the main target of antifungals that are currently used to treat fatal fungal infections. Emergence of resistance to existing antifungals is a current problem and several secondary resistance mechanisms have been described in Aspergillus fumigatus clinical isolates. A full understanding of ergosterol biosynthetic control therefore appears to be essential for improvement of antifungal efficacy and to prevent antifungal resistance. An ergosterol biosynthesis pathway in A. fumigatus has been proposed with 14 sterol intermediates resulting in ergosterol and another secondary final compound C-24 ethyl sterol. Transcriptomic analysis of the A. fumigatus response to host-imposed stresses or antifungal agents is expanding our understanding of both sterol biosynthesis and the modes of action of antifungal drugs. Ultimately, the identification of new targets for novel drug design, or the study of combinatorial effects of targeting sterol biosynthesis together with other metabolic pathways, is warranted.
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Affiliation(s)
- Laura Alcazar-Fuoli
- Mycology Reference Laboratory, Centro Nacional de Microbiologia, Instituto de Salud Carlos III, Madrid, Spain
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In vitro susceptibility of environmental isolates of Exophiala dermatitidis to five antifungal drugs. Mycopathologia 2012; 175:455-61. [PMID: 23229615 DOI: 10.1007/s11046-012-9597-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 10/24/2012] [Indexed: 10/27/2022]
Abstract
Several dematiaceous fungi frequently isolated from nature are involved in cases of superficial lesions to lethal cerebral infections. Antifungal susceptibility data on environmental and clinical isolates are still sparse despite the advances in testing methods. The objective of this study was to examine the activities of 5-flucytosine, amphotericin B, itraconazole, voriconazole and terbinafine against environmental isolates of Exophiala strains by minimum inhibition concentration (MIC) determination. The strains were obtained from hydrocarbon-contaminated soil, ant cuticle and fungal pellets from the infrabuccal pocket of attine gynes. Broth microdilution assay using M38-A2 reference methodology for the five antifungal drugs and DNA sequencing for fungal identification were applied. Terbinafine was the most active drug against the tested strains. It was observed that amphotericin B was less effective, notably against Exophiala spinifera, also studied. High MICs of 5-flucytosine against Exophiala dermatitidis occurred. This finding highlights the relevance of studies on the antifungal resistance of these potential opportunistic species. Our results also contribute to a future improvement of the standard methods to access the drug efficacy currently applied to black fungi.
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Contribution to investigation of antimicrobial activity of styrylquinolines. Bioorg Med Chem 2012; 20:6960-8. [PMID: 23159041 DOI: 10.1016/j.bmc.2012.10.027] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 10/05/2012] [Accepted: 10/14/2012] [Indexed: 11/18/2022]
Abstract
Series of new ring-substituted styrylquinolines and two oxorhenium complexes were prepared and characterized. The compounds were analyzed using RP-HPLC to determine lipophilicity. Primary in vitro screening of the synthesized compounds was performed against fungal and bacterial strains. Some compounds were active against bacteria at micromolar level and against fungi at submicromolar level. Compounds 5,7-dichloro-2-[2-(2-ethoxyphenyl)vinyl]quinolin-8-ol expressed excellent antifungal activity comparable with or higher than the standard fluconazole as well as antibacterial activity against Staphylococcus strains comparable with or higher than the standards bacitracin, penicillin and ciprofloxacin. The structure-activity relationships are discussed.
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Chen YC, Liu DZ, Liu JJ, Chang TW, Ho HO, Sheu MT. Development of terbinafine solid lipid nanoparticles as a topical delivery system. Int J Nanomedicine 2012; 7:4409-18. [PMID: 22923986 PMCID: PMC3423152 DOI: 10.2147/ijn.s33682] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
To resolve problems of long treatment durations and frequent administration of the antifungal agent terbinafine (TB), solid lipid nanoparticles (SLNs) with the ability to load lipophilic drugs and nanosize were developed. The SLNs were manufactured by a microemulsion technique in which glyceryl monostearate (GMS), glyceryl behenate (Compritol® 888; Gattefossé), and glyceryl palmitostearate (Precirol® ATO 5; Gattefossé) were used as the solid lipid phases, Tween® and Cremophor® series as the surfactants, and propylene glycol as the cosurfactant to construct ternary phase diagrams. The skin of nude mice was used as a barrier membrane, and penetration levels of TB of the designed formulations and a commercial product, Lamisil® Once™ (Novartis Pharmaceuticals), in the stratum corneum (SC), viable epidermis, and dermis were measured; particle sizes were determined as an indicator of stability. The optimal SLN system contained a <5% lipid phase and >50% water phase. The addition of ethanol or etchants had no significant effect on enhancing the amount of TB that penetrated the skin layers, but it was enhanced by increasing the percentage of the lipid phase. Furthermore, the combination of GMS and Compritol® 888 was able to increase the stable amount of TB that penetrated all skin layers. For the ACP1-GM1 (4% lipid phase; Compritol® 888: GMS of 1:1) formulation, the amount of TB that penetrated the SC was similar to that of Lamisil® Once™, whereas the amount of TB of the dermis was higher than that of Lamisil® Once™ at 12 hours, and it was almost the same as that of Lamisil® Once™ at 24 hours. It was concluded that the application of ACP1-GM1 for 12 hours might have an efficacy comparable to that of Lamisil® Once™ for 24 hours, which would resolve the practical problem of the longer administration period that is necessary for Lamisil® Once™.
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Affiliation(s)
- Ying-Chen Chen
- School of Pharmacy, College of Pharmacy, Taipei Medical University Hospital, Taipei, Taiwan
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Guerra CR, Ishida K, Nucci M, Rozental S. Terbinafine inhibits Cryptococcus neoformans growth and modulates fungal morphology. Mem Inst Oswaldo Cruz 2012; 107:582-90. [DOI: 10.1590/s0074-02762012000500003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Accepted: 12/07/2011] [Indexed: 11/21/2022] Open
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Olsen GL, Deitz KL, Flaherty HA, Lockhart SR, Hurst SF, Haynes JS. Use of Terbinafine in the Treatment Protocol of Intestinal Cryptococcus neoformans in a Dog. J Am Anim Hosp Assoc 2012; 48:216-20. [DOI: 10.5326/jaaha-ms-5813] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 2.5 yr old sexually intact male vizsla was admitted to the Iowa State University Veterinary Teaching Hospital for persistent diarrhea, weight loss, and panhypoproteinemia. Examination revealed an emaciated condition and melena. Two masses were palpated in the cranial abdomen. Hematology and serum biochemistry exhibited a regenerative anemia and confirmed the presence of panhypoproteinemia, suggestive of a protein-losing eneteropathy. Distinct areas of thickened intestinal wall and enlarged mesenteric lymph nodes were found on abdominal ultrasound. Cytology from those nodes showed the presence of suspected Cryptococcus spp., and infection was confirmed utilizing a cryptococcal antigen titer. Medical therapy with lipid-complexed amphotericin B and fluconazole was unsuccessful. Two surgical procedures were performed to remove the affected areas of intestine and lymph nodes, but the disease persisted as evidenced by a persistently elevated cryptococcal antigen titer. Terbinafine was prescribed, which resulted in complete resolution of clinical signs and a steadily decreasing cryptococcal antigen titer. Very few cases of intestinal cryptococcosis have been reported. In this case, infection resulted in a protein-losing enteropathy. In addition, this article describes the use of terbinafine in the treatment of intestinal cryptococcal infection in the dog, which has not been previously reported.
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Affiliation(s)
- Gavin L. Olsen
- Department of Veterinary Clinical Sciences, Internal Medicine Services, Iowa State University Veterinary Teaching Hospital, Ames, IA (G.O., K.D., H.F., J.H.); and Antifungal Drug Unit, Fungal Reference Unit, Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA (S.L., S.H.)
| | - Krysta L. Deitz
- Department of Veterinary Clinical Sciences, Internal Medicine Services, Iowa State University Veterinary Teaching Hospital, Ames, IA (G.O., K.D., H.F., J.H.); and Antifungal Drug Unit, Fungal Reference Unit, Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA (S.L., S.H.)
| | - Heather A. Flaherty
- Department of Veterinary Clinical Sciences, Internal Medicine Services, Iowa State University Veterinary Teaching Hospital, Ames, IA (G.O., K.D., H.F., J.H.); and Antifungal Drug Unit, Fungal Reference Unit, Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA (S.L., S.H.)
| | - Shawn R. Lockhart
- Department of Veterinary Clinical Sciences, Internal Medicine Services, Iowa State University Veterinary Teaching Hospital, Ames, IA (G.O., K.D., H.F., J.H.); and Antifungal Drug Unit, Fungal Reference Unit, Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA (S.L., S.H.)
| | - Steven F. Hurst
- Department of Veterinary Clinical Sciences, Internal Medicine Services, Iowa State University Veterinary Teaching Hospital, Ames, IA (G.O., K.D., H.F., J.H.); and Antifungal Drug Unit, Fungal Reference Unit, Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA (S.L., S.H.)
| | - Joseph S. Haynes
- Department of Veterinary Clinical Sciences, Internal Medicine Services, Iowa State University Veterinary Teaching Hospital, Ames, IA (G.O., K.D., H.F., J.H.); and Antifungal Drug Unit, Fungal Reference Unit, Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA (S.L., S.H.)
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Abstract
INTRODUCTION Onychomycosis is a fungal infection of the nail apparatus that affects 10 - 30% of the global population. Current therapeutic options for onychomycosis have a low to moderate efficacy and result in a 20 - 25% rate of relapse and reinfection. New therapeutic options are needed to broaden the spectrum of treatment options and improve the efficacy of treatment. AREAS COVERED This review discusses the emerging pharmacotherapeutics; including topical reformulations of terbinafine, new azole molecules for systemic and topical administration, topical benzoxaboroles and topical polymer barriers. The paper also discusses device-based options, which may be designed to activate a drug or to improve drug delivery, such as photodynamic therapy and iontophoresis; laser device systems have also begun to receive regulatory approval for onychomycosis. EXPERT OPINION Device-based therapeutic options for onychomycosis are expanding more rapidly than pharmacotherapy. Systemic azoles are the only class of pharmacotherapy that has shown a comparable efficacy to systemic terbinafine; however terbinafine remains the gold standard. The most notable new topical drugs are tavaborole, efinaconazole and luliconazole, which belong to the benzoxaborole and azole classes of drugs. Photodynamic therapy, iontophoresis and laser therapy have shown positive initial results, but randomized controlled trials are necessary to determine the long-term success of these devices.
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Affiliation(s)
- Aditya K Gupta
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
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Sakai MR, May ER, Imerman PM, Felz C, Day TA, Carlson SA, Noxon JO. Terbinafine pharmacokinetics after single dose oral administration in the dog. Vet Dermatol 2011; 22:528-34. [PMID: 21599768 DOI: 10.1111/j.1365-3164.2011.00985.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Terbinafine is an allylamine antifungal prescribed for the treatment of mycoses in humans. It is increasingly being used in veterinary patients. The purpose of this study was to evaluate the pharmacokinetic properties of terbinafine in dogs after a single oral dose. Ten healthy adult dogs were included in the study. A single dose of terbinafine (30-35 mg/kg) was administered orally, and blood samples were periodically collected over a 24 h period during which dogs were monitored for adverse effects. Two of 10 dogs developed transient ocular changes. A high-performance liquid chromatography assay was developed and used to determine plasma terbinafine concentrations. Pharmacokinetic analysis was performed using PK Solutions(®) computer software. Area under the curve (AUC) from time 0 to 24 h was 15.4 μg·h/mL (range 5-27), maximal plasma concentration (C(max) ) was 3.5 μg/mL (range 3-4.9 μg/mL) and time to C(max) (T(max) ) was 3.6 h (range 2-6 h). The time above minimal inhibitory concentration (T > MIC) as well as AUC/MIC was calculated for important invasive fungal pathogens and dermatophytes. The T > MIC was 17-18 h for Blastomyces dermatitidis, Histoplasma capsulatum and dermatophytes (Microsporum spp. and Trichophyton mentagrophytes), while the MIC for Sporothrix schenckii and Coccidioides immitis was exceeded for 9.5-11 h. The AUC/MIC values ranged from 9 to 13 μg h/mL for these fungi. Our results provide evidence supporting the use of terbinafine as an oral therapeutic agent for treating systemic and subcutaneous mycoses in dogs.
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Affiliation(s)
- Mary R Sakai
- Department of Veterinary Clinical Sciences, Iowa State University, Ames, IA 50011, USA.
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Foy DS, Trepanier LA. Antifungal treatment of small animal veterinary patients. Vet Clin North Am Small Anim Pract 2011; 40:1171-88. [PMID: 20933143 DOI: 10.1016/j.cvsm.2010.07.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Antifungal therapy has progressed significantly with the development of new drugs directed at various processes in fungal cell metabolism. Within veterinary medicine, treatment options for systemic mycoses remain limited to amphotericin B, ketoconazole, fluconazole, and itraconazole. However, newer triazoles, echinocandins, and lipid-based formulations of amphotericin B are now approved for use in humans. This article provides a comprehensive review of the antifungal medications available for veterinary patients, and includes a brief discussion of the newer, presently cost-prohibitive, antifungal therapies used for systemic mycoses in humans.
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Affiliation(s)
- Daniel S Foy
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Drive, Madison, WI 53706, USA.
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Antifungal Activity of Antifungal Drugs, as Well as Drug Combinations Against Exophiala dermatitidis. Mycopathologia 2010; 171:111-7. [DOI: 10.1007/s11046-010-9358-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Accepted: 08/16/2010] [Indexed: 11/27/2022]
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Permeation studies of novel terbinafine formulations containing hydrophobins through human nails in vitro. Int J Pharm 2010; 397:67-76. [PMID: 20620203 DOI: 10.1016/j.ijpharm.2010.06.051] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Revised: 06/26/2010] [Accepted: 06/30/2010] [Indexed: 11/21/2022]
Abstract
Existing treatments of onychomycosis are not satisfactory. Oral therapies have many side effects and topical formulations are not able to penetrate into the human nail plate and deliver therapeutical concentrations of active agent in situ. The purpose of the present study was to determine the amount of terbinafine, which permeates through the human nail plate, from liquid formulations containing enhancers, namely hydrophobins A-C in the concentration of 0.1% (w/v). The used reference solution contained 10% (w/v) of terbinafine in 60% (v/v) ethanol/water without enhancer. Permeability studies have been performed on cadaver nails using Franz diffusion cells modified to mount nail plates and filled with 60% (v/v) ethanol/water in the acceptor chamber. Terbinafine was quantitatively determined by HPLC. The amount of terbinafine remaining in the nail was extracted by 96% ethanol from pulverized nail material after permeation experiment and presented as percentage of the dry nail weight before the milling test. Permeability coefficient (PC) of terbinafine from reference solution was determined to be 1.52E-10 cm/s. Addition of hydrophobins improved PC in the range of 3E-10 to 2E-9 cm/s. Remaining terbinafine reservoir in the nail from reference solution was 0.83% (n=2). An increase of remaining terbinafine reservoir in the nail was observed in two out of three tested formulations containing hydrophobins compared to the reference. In all cases, known minimum inhibitory concentration of terbinafine for dermatophytes (0.003 microg/ml) has been exceeded in the acceptor chamber of the diffusion cells. All tested proteins (hydrophobins) facilitated terbinafine permeation after 10 days of permeation experiment, however one of them achieved an outstanding enhancement factor of 13.05 compared to the reference. Therefore, hydrophobins can be included in the list of potential enhancers for treatment of onychomycosis.
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Abstract
This review provides a historical overview of the analog based drug discovery of miconazole and its congeners, and is focused on marketed azole antifungals bearing the generic suffix “conazole”. The antifungal activity of miconazole, one of the first broad-spectrum antimycotic agents has been mainly restricted to topical applications. The attractive in vitro antifungal spectrum was a starting point to design more potent and especially orally active antifungal agents such as ketoconazole, itraconazole, posaconazole, fluconazole and voriconazole. The chemistry, in vitro and in vivo antifungal activity, pharmacology, and clinical applications of these marketed conazoles has been described.
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