1
|
Baghirova AA, Kasumov KM. Antifungal Macrocycle Antibiotic Amphotericin B-Its Present and Future. Multidisciplinary Perspective for the Use in the Medical Practice. BIOCHEMISTRY (MOSCOW) SUPPLEMENT. SERIES B, BIOMEDICAL CHEMISTRY 2022; 16:1-12. [PMID: 35194486 PMCID: PMC8853366 DOI: 10.1134/s1990750822010024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 06/15/2021] [Accepted: 06/22/2021] [Indexed: 12/13/2022]
Abstract
This review is devoted to a broad analysis of the results of studies of the effect of macrocyclic antifungal polyene antibiotic amphotericin B on cell membranes. A detailed study of polyenes has shown that some of them can have not only antifungal, but also antiviral and antitumor effects. Under conditions of global pandemic fungal pathology develops especially quickly and in this case leads to invasive aspergillosis, which contributes to the complication of coronavirus infection in the lungs and even secondary infection with invasive aspergillosis. The treatment of an invasive form of bronchopulmonary aspergillosis is directly related to the immunomodulatory and immunostimulating properties of the macrocyclic polyene drug amphotericin B. The article presents experimental data on the study of the biological activity and membrane properties of amphotericin B and the effect of its chemically modified derivatives, as well as liposomal forms of amphotericin B on viral, bacterial and fungal infections. The mechanism of action of amphotericin B and its analogues is based on their interaction with cellular and lipid membranes, followed by formation of ion channels of molecular size in the membranes. The importance of these studies is that polyenes are sensitive to membranes that contain sterols of a certain structure. The analysis showed that pathogenic fungal cells containing ergosterol were 10-100 times more sensitive to polyene antibiotics than host cell membranes containing cholesterol. The high sterol selectivity of the action of polyenes opens broad prospects for the use of polyene antifungal drugs in practical medicine and pharmacology in the treatment of invasive mycoses and the prevention of atherosclerosis. In this context, it should be noted that polyene antibiotics are the main tool in the study of the biochemical mechanism of changes in the permeability of cell membranes for energy-dependent substrates. Chemical and genetic engineering transformation of the structure of polyene antibiotic molecules opens prospects for the identification and creation of new biologically active forms of the antibiotic that have a high selectivity of action in the treatment of pathogenic infections.
Collapse
Affiliation(s)
- A. A. Baghirova
- Institute of Botany, Azerbaijan National Academy of Sciences, Patamdartskoe shosse 40, AZ1004 Baku, Azerbaijan
| | - Kh. M. Kasumov
- Institute of Botany, Azerbaijan National Academy of Sciences, Patamdartskoe shosse 40, AZ1004 Baku, Azerbaijan
| |
Collapse
|
2
|
Farah N, Chin VK, Chong PP, Lim WF, Lim CW, Basir R, Chang SK, Lee TY. Riboflavin as a promising antimicrobial agent? A multi-perspective review. CURRENT RESEARCH IN MICROBIAL SCIENCES 2022; 3:100111. [PMID: 35199072 PMCID: PMC8848291 DOI: 10.1016/j.crmicr.2022.100111] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 02/05/2022] [Accepted: 02/07/2022] [Indexed: 12/29/2022] Open
Abstract
Riboflavin demonstrates antioxidant and photosensitizing properties. Riboflavin is able to induce ROS and modulate immune response. Riboflavin possesses potent antimicrobial activity when used alone or combined with other anti-infectives. The riboflavin biosynthesis pathway serves as an ideal drug target against microbes. UVA combination with riboflavin exhibits remarkable antimicrobial effects.
Riboflavin, or more commonly known as vitamin B2, forms part of the component of vitamin B complex. Riboflavin consisting of two important cofactors, flavin mononucleotide (FMN) and flavin adenine dinucleotide (FAD), which are involved in multiple oxidative-reduction processes and energy metabolism. Besides maintaining human health, different sources reported that riboflavin can inhibit or inactivate the growth of different pathogens including bacteria, viruses, fungi and parasites, highlighting the possible role of riboflavin as an antimicrobial agent. Moreover, riboflavin and flavins could produce reactive oxygen species (ROS) when exposed to light, inducing oxidative damage in cells and tissues, and thus are excellent natural photosensitizers. Several studies have illustrated the therapeutic efficacy of photoactivated riboflavin against nosocomial infections and multidrug resistant bacterial infections as well as microbial associated biofilm infections, revealing the potential role of riboflavin as a promising antimicrobial candidate, which could serve as one of the alternatives in fighting the global crisis of the emergence of antimicrobial resistance seen in different pathogenic microbes. Riboflavin could also be involved in modulating host immune responses, which might increase the pathogen clearance from host cells and increase host defense against microbial infections. Thus, the dual effects of riboflavin on both pathogens and host immunity, reflected by its potent bactericidal effect and alleviation of inflammation in host cells further imply that riboflavin could be a potential candidate for therapeutic intervention in resolving microbial infections. Hence, this review aimed to provide some insights on the promising role of riboflavin as an antimicrobial candidate and also a host immune-modulator from a multi-perspective view as well as to discuss the application and challenges on using riboflavin in photodynamic therapy against various pathogens and microbial biofilm-associated infections.
Collapse
Affiliation(s)
- Nuratiqah Farah
- Department of Human Anatomy, Faculty of Medicine and Health Sciences, UPM, 43400, Serdang, Selangor, Malaysia
| | - Voon Kin Chin
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, UPM, 43400, Serdang, Selangor, Malaysia
| | - Pei Pei Chong
- School of Biosciences, Taylor's University, No 1, Jalan Taylor's, 47500 Subang Jaya, Selangor, Malaysia
| | - Wai Feng Lim
- Integrative Pharmacogenomics Institute (iPROMISE), Universiti Teknologi MARA, Puncak Alam Campus, 42300 Bandar Puncak Alam, Selangor, Malaysia
| | - Chee Woei Lim
- Department of Medicine, Faculty of Medicine and Health Sciences, UPM, 43400, Serdang, Selangor, Malaysia
| | - Rusliza Basir
- Department of Human Anatomy, Faculty of Medicine and Health Sciences, UPM, 43400, Serdang, Selangor, Malaysia
| | - Sui Kiat Chang
- Department of Horticulture, Key Laboratory of South China Agricultural Plant Molecular Analysis and Genetic Improvement, Key Laboratory of Post-Harvest Handling of Fruits, Ministry of Agriculture. South China Botanical Garden, Chinese Academy of Sciences. Guangzhou, 510650 China
| | - Tze Yan Lee
- Perdana University School of Liberal Arts, Science and Technology (PUScLST), Suite 9.2, 9th Floor, Wisma Chase Perdana, Changkat Semantan, Damansara Heights, 50490 Kuala Lumpur, Malaysia
- Corresponding author.
| |
Collapse
|
3
|
Baghirova AA, Kasumov KM. [Antifungal macrocycle antibiotic amphotericin B - its present and future. Multidisciplinary perspective for the use in the medical practice]. BIOMEDIT︠S︡INSKAI︠A︡ KHIMII︠A︡ 2021; 67:311-322. [PMID: 34414889 DOI: 10.18097/pbmc20216704311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This review is devoted to a broad analysis of the results of studies of the effect of macrocyclic antifungal polyene antibiotic amphotericin B on cell membranes. A multi-prolonged study of polyenes showed that some of them can have not only antifungal, but also antiviral and antitumor action. Fungal pathology develops especially quickly and in this case leads to invasive aspergillosis, which contributes to the complication of coronavirus infection in the lungs and even secondary infection with invasive aspergillosis in the context of a global pandemic. The treatment of an invasive form of bronchopulmonary aspergillosis is directly related to the immunomodulatory and immunostimulating properties of the macrocyclic polyene drug amphotericin B. The article presents experimental data on the study of the biological activity and membrane properties of amphotericin B and the effect of its chemically modified derivatives, as well as liposomal forms of amphotericin B on viral, bacterial and fungal infections. The mechanism of action of amphotericin B and its analogues is based on their interaction with cellular and lipid membranes, by forming ion channels of molecular size in them. The importance of these studies is that polyenes are sensitive to membranes that contain sterols of a certain structure. The analysis showed that pathogenic fungal cells containing ergosterol were 10-100 times more sensitive to polyene antibiotics than host cell membranes containing cholesterol. The high sterol selectivity of the action of polyenes opens up broad prospects for the use of polyene antifungal drugs in practical medicine and pharmacology in the treatment of invasive mycoses and the prevention of atherosclerosis. In this connection, it should be noted that polyene antibiotics are the main tool in the study of the biochemical mechanism of changes in the permeability of cell membranes for energy-dependent substrates. Chemical and genetic engineering transformation of the structure of polyene antibiotic molecules opens up prospects for the identification and creation of new biologically active forms of the antibiotic that have a high selectivity of action in the treatment of pathogenic infections.
Collapse
Affiliation(s)
- A A Baghirova
- Institute of Botany, Azerbaijan National Academy of Sciences, Baku, Azerbaijan
| | - Kh M Kasumov
- Institute of Botany, Azerbaijan National Academy of Sciences, Baku, Azerbaijan
| |
Collapse
|
4
|
Sha XY, Shi Q, Liu L, Zhong JX. Update on the management of fungal keratitis. Int Ophthalmol 2021; 41:3249-3256. [PMID: 33929644 DOI: 10.1007/s10792-021-01873-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 04/19/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE The aim of this article is to introduce the recent advance on the studies of fungal keratitis published over past 5 years. METHODS We performed literature review of articles published on PubMed, Google Scholar, CNKI and Web of Science relevant to the diagnosis, pathogenesis and novel treatment of fungal keratitis. RESULTS Excessive inflammation can lead to stromal damage and corneal opacification, hence the research on immune mechanism provides many potential therapeutic targets for fungal keratitis. Many researchers discussed the importance of earlier definitive diagnosis and were trying to find rapid and accurate diagnostic methods of pathogens. Develop new drug delivery systems and new routes of administration with better corneal penetration, prolonged ocular residence time, and better mucoadhesive properties is also one of the research hotspots. Additionally, many novel therapeutic agents and methods have been gradually applied in clinical ophthalmology. CONCLUSION The diagnosis and treatment of fungal keratitis are still a challenge for ophthalmologist, and many researches provide new methods to conquer these problems.
Collapse
Affiliation(s)
- Xiao-Yuan Sha
- Department of Ophthalmology, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Qi Shi
- Department of Ophthalmology, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Lian Liu
- Department of Ophthalmology, First Affiliated Hospital of Jinan University, Guangzhou, China.
| | - Jing-Xiang Zhong
- Department of Ophthalmology, First Affiliated Hospital of Jinan University, Guangzhou, China
| |
Collapse
|
5
|
Li J, Li Z, Liang Z, Han L, Feng H, He S, Zhang J. Fabrication of a drug delivery system that enhances antifungal drug corneal penetration. Drug Deliv 2018; 25:938-949. [PMID: 29658325 PMCID: PMC6058611 DOI: 10.1080/10717544.2018.1461278] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Fungal keratitis (FK) remains a severe eye disease, and effective therapies are limited by drug shortages and critical ocular barriers. Despite the high antifungal potency and broad spectrum of econazole, its strong irritant and insolubility in water hinder its ocular application. We designed and fabricated a new drug delivery system based on a polymeric vector for the ocular antifungal application of econazole. This novel system integrates the advantages of its constituent units and exhibits superior comprehensive performance. Using the new system, drug content was significantly increased more than 600 folds. The results of in vivo and in vitro experiments demonstrated that the econazole-loaded formulation exhibited significantly enhanced corneal penetration after a single topical ocular administration, excellent antifungal activity, and good tolerance in rabbits. Drug concentrations and ocular relative bioavailability in the cornea were 59- and 29-time greater than those in the control group, respectively. Following the topical administration of one eye drop (50 μL of 0.3% w/v econazole) in fungus-infected rabbits, a high concentration of antimycotic drugs in the cornea and aqueous humor was sustained and effective for 4 h. The mechanism of corneal penetration was also explored using dual fluorescent labeling. This novel drug delivery system is a promising therapeutic approach for oculomycosis and could serve as a candidate strategy for use with various hydrophobic drugs to overcome barriers in the treatment of many other ocular diseases.
Collapse
Affiliation(s)
- Jingguo Li
- a Henan Key Laboratory of Ophthalmology and Visual Science , Henan Eye Hospital, People's Hospital of Zhengzhou University , Zhengzhou , P. R. China
| | - Zhanrong Li
- a Henan Key Laboratory of Ophthalmology and Visual Science , Henan Eye Hospital, People's Hospital of Zhengzhou University , Zhengzhou , P. R. China
| | - Zhen Liang
- a Henan Key Laboratory of Ophthalmology and Visual Science , Henan Eye Hospital, People's Hospital of Zhengzhou University , Zhengzhou , P. R. China
| | - Lei Han
- a Henan Key Laboratory of Ophthalmology and Visual Science , Henan Eye Hospital, People's Hospital of Zhengzhou University , Zhengzhou , P. R. China
| | - Huayang Feng
- a Henan Key Laboratory of Ophthalmology and Visual Science , Henan Eye Hospital, People's Hospital of Zhengzhou University , Zhengzhou , P. R. China
| | - Siyu He
- a Henan Key Laboratory of Ophthalmology and Visual Science , Henan Eye Hospital, People's Hospital of Zhengzhou University , Zhengzhou , P. R. China
| | - Junjie Zhang
- a Henan Key Laboratory of Ophthalmology and Visual Science , Henan Eye Hospital, People's Hospital of Zhengzhou University , Zhengzhou , P. R. China
| |
Collapse
|
6
|
Synthetic β-sheet forming peptide amphiphiles for treatment of fungal keratitis. Biomaterials 2014; 43:44-9. [PMID: 25591960 DOI: 10.1016/j.biomaterials.2014.11.052] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 11/09/2014] [Accepted: 11/25/2014] [Indexed: 01/09/2023]
Abstract
Fungal keratitis is a leading cause of ocular morbidity. It is frequently misdiagnosed as bacterial keratitis, causing a delay in proper treatment. Furthermore, due to the lack of safe and effective anti-fungal agents for clinical use, treatment of fugal keratitis remains a challenge. In recent years, antimicrobial peptides (AMPs) have received considerable attention as potent and broad-spectrum antimicrobial agents with the potential to overcome antibiotics resistance. We previously reported the design of short synthetic β-sheet forming peptides (IKIK)2-NH2 and (IRIK)2-NH2 with excellent antimicrobial activities and selectivities against various clinically relevant microorganisms, including Gram-positive Staphylococcus epidermidis and Staphylococcus aureus, Gram-negative Escherichia coli and Pseudomonas aeruginosa, and yeast Candida albicans (C. albicans). In this study, we evaluated the application of the two most promising synthetic β-sheet forming peptide candidates for in vivo fungal keratitis treatment in comparison with the commercially available amphotericin B. It was found that topical solutions of the designed peptides are safe, and as effective as the clinically used amphotericin B. Compared to the costly and unstable amphotericin B, (IKIK)2-NH2 and (IRIK)2-NH2 are water-soluble, less expensive and stable. Thus, the synthetic β-sheet forming peptides are presented as promising candidates for the treatment of fungal keratitis.
Collapse
|
7
|
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.
Collapse
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.
| |
Collapse
|
8
|
|
9
|
Kashiwabuchi RT, Carvalho FRS, Khan YA, Hirai F, Campos MS, McDonnell PJ. Assessment of fungal viability after long-wave ultraviolet light irradiation combined with riboflavin administration. Graefes Arch Clin Exp Ophthalmol 2012. [PMID: 23180236 DOI: 10.1007/s00417-012-2209-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Corneal collagen cross-linking (CXL), a technique that combines riboflavin administration with long-wave ultraviolet light irradiation, was primarily developed to increase the biomechanical strength of collagen fibrils of the cornea to avoid the progression of keratoconus. Recently, this method has been proposed to treat selected cases of infectious keratitis. METHODS To test the protocol used for progressive keratoconus in infectious keratitis, Candida albicans, and Fusarium solani, strains were exposed to irradiation using a wavelength of 365 nm at a power density of 3 mW/cm(2) for 30 min in the presence of riboflavin photosensitizer. All experiments were performed in triplicate. Qualitative and quantitative measurements of fungal viability used plate cultures and an automated trypan blue dye exclusion method respectively. Fungal cell diameter was also assessed in all groups. Statistical analyses were performed using the triplicate values of each experimental condition. RESULTS Experimental findings of photodynamic therapy applied to the cell inactivation of both yeasts and filamentous fungi were compared with control groups. Qualitative results were corroborated with quantitative findings which showed no statistical significance between challenged samples (experimental groups) and the control group (p-value = 1). In comparison with a control group of live cells, statistical significance was observed when riboflavin solution alone had an effect on the morphologic size of filamentous fungi, while ultraviolet light irradiation alone showed a slight decrease in the cell structure of C. albicans. CONCLUSIONS The impact of long-wave ultraviolet combined with riboflavin photosensitizer showed no antifungal effect on C. albicans and F. solani. The significant decrease in cell morphology of both filamentous fungi and yeasts submitted to photosensitizing riboflavin and exposure to ultraviolet light, respectively, may be promising in the development and standardization of alternatives for fungal cell inactivation, because of their minimal cytotoxic effects on the corneal surface. The methodological improvement in the preparation and application of individual chemical compounds, such as riboflavin, or physical systems, such as a long-wave light source, as antifungal agents may also assist in establishing promising therapeutic procedures for keratomycosis.
Collapse
Affiliation(s)
- Renata T Kashiwabuchi
- Department of Ophthalmology, Paulista School of Medicine - Federal University of Sao Paulo - UNIFESP, Sao Paulo, Brazil.
| | | | | | | | | | | |
Collapse
|
10
|
Liu L, Wu H, Riduan SN, Ying JY, Zhang Y. Short imidazolium chains effectively clear fungal biofilm in keratitis treatment. Biomaterials 2012; 34:1018-23. [PMID: 23146429 DOI: 10.1016/j.biomaterials.2012.10.050] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Accepted: 10/22/2012] [Indexed: 01/22/2023]
Abstract
Fungal keratitis is a leading cause of ocular morbidity throughout the world. However, current therapies against fungal keratitis are often ineffective. Herein, we have developed the amphiphilic main-chain imidazolium polymer (PIM-45) and oligomer (IBN-1) materials that can efficiently inhibit the growth of fungi with low minimal inhibition concentration (MIC) values and clear the fungal biofilm, while displaying minimal hemolysis. In vivo keratitis treatment indicates that topical solutions of these polyimidazolium salts (PIMSs) are safe and as effective as that of amphotericin B, the most commonly used agent for the treatment of Candida albicans (C. albicans) keratitis. Compared to the costly and unstable amphotericin B and fluconazole, PIM-45 and IBN-1 are easy to prepare, inexpensive and stable. They can be stored in phosphate-buffered saline (PBS) solutions with long shelf life for routine topical use.
Collapse
Affiliation(s)
- Lihong Liu
- Institute of Bioengineering and Nanotechnology, 31 Biopolis Way, Singapore 138669, Singapore
| | | | | | | | | |
Collapse
|
11
|
Al-Badriyeh D, Neoh CF, Stewart K, Kong DCM. Clinical utility of voriconazole eye drops in ophthalmic fungal keratitis. Clin Ophthalmol 2010; 4:391-405. [PMID: 20463910 PMCID: PMC2866570 DOI: 10.2147/opth.s6374] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Indexed: 11/23/2022] Open
Abstract
Fungal keratitis is one of the major causes of ophthalmic mycosis and is difficult to treat. The range of common antifungal agents available for fungal keratitis remains inadequate and is generally associated with poor clinical outcomes. Voriconazole is a new generation triazole antifungal agent. Only marketed in systemic formulation and, with broad-spectrum activity and high intraocular penetration, voriconazole has demonstrated effectiveness against fungal keratitis. Systemic voriconazole, however, is not without side effects and is costly. Voriconazole eye drops have been prepared extemporaneously and used for the treatment of ophthalmic fungal keratitis. The current article sought to review the literature for evidence related to the effectiveness and safety of topical voriconazole and its corneal penetration into the aqueous humor of the eye. The voriconazole eye drops used are typically of 1% concentration, well tolerated by the eye, and are stable. Despite existing evidence to suggest that the eye drops are effective in the treatment of fungal keratitis, more studies are needed, especially in relation to using the eye drops as first-line and stand-alone treatment, preparation of higher concentrations, and optimal dosing frequency.
Collapse
Affiliation(s)
- Daoud Al-Badriyeh
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Victoria, Australia
| | - Chin Fen Neoh
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Victoria, Australia
| | - Kay Stewart
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Victoria, Australia
| | - David CM Kong
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Victoria, Australia
| |
Collapse
|
12
|
Li L, Wang Z, Li R, Luo S, Sun X. In vitro evaluation of combination antifungal activity against Fusarium species isolated from ocular tissues of keratomycosis patients. Am J Ophthalmol 2008; 146:724-8. [PMID: 18707669 DOI: 10.1016/j.ajo.2008.06.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2008] [Revised: 06/04/2008] [Accepted: 06/07/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE To determine the minimum inhibitory concentrations (MICs) of five antifungal agents against Fusarium species isolated from ocular tissues and to evaluate anti-Fusarium species activities of eight combination treatments in vitro. DESIGN Experimental research. METHODS Thirty-eight isolates of Fusarium species were collected from patients' ocular tissues and were cultured in vitro. The MICs of natamycin, terbinafine, itraconazole fluconazole, and amphotericin B, either used alone or combined with other compounds, were evaluated by checkerboard microdilution technique based on the Clinical Laboratory Standards Institute proposed standard. The interactions were assessed using the Fractional Inhibitory Concentration Index model. RESULTS In the MIC study, the MIC(90) of each drug used alone were: natamycin, 16 microg/ml; terbinafine, 8 microg/ml; itraconazole, >16 microg/ml; fluconazole, >64 microg/ml; and amphotericin B, 4 microg/ml. Synergism was obtained in the amphotericin B plus terbinafine (81.6%) group and in the amphotericin B plus itraconazole (84.2%) group, with an obviously decreased MIC value of amphotericin B. Antagonism was shown in the natamycin plus azoles and in the natamycin plus terbinafine groups in 52.6% to 60.5% of Fusarium species strains. CONCLUSIONS Amphotericin B plus terbinafine or itraconazole demonstrated more effective anti-Fusarium species activity than single-use in vitro treatment, which implies that these combinations may be helpful in treating fungal keratitis. The combinations of natamycin plus azoles or natamycin plus terbinafine were not satisfactory and can be avoided. Further in vivo studies are needed to elucidate the potential usefulness of these combination therapies.
Collapse
|
13
|
Shi W, Li S, Liu M, Jin H, Xie L. Antifungal chemotherapy for fungal keratitis guided by in vivo confocal microscopy. Graefes Arch Clin Exp Ophthalmol 2007; 246:581-6. [DOI: 10.1007/s00417-007-0719-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2007] [Revised: 10/19/2007] [Accepted: 10/27/2007] [Indexed: 11/30/2022] Open
|