amphotericin-b and tioconazole

The results of all the controlled trials carried out at the Department of Genito-Urinary Medicine at the Cardiff Royal Infirmary over the past 16 years are summarized. All except one of these trials were carried out with patients having acute vulvovaginal candidiasis. One trial involved treating only patients with recurring candidal infection. In all the acute trials, there were practically no mycologic relapses 7 days after completion of treatment whatever the regimen used, but at 35 days after completion of treatment the mycologic relapse rate was in the region of 20% to 25%. It is concluded that following the elimination of any known predisposing cause of vaginal candidiasis, the intravaginal application of 500 mg of an imidazole preparation is as effective a treatment as any other regimen. In recurrent cases, monthly treatment with such a dose may be adequate to control the patient's symptoms. Mycologic relapse may not be accompanied by symptoms, but in recurrent cases there is a closer relation between mycologic relapse and symptoms.

Topics: Amphotericin B; Antifungal Agents; Candidiasis, Vulvovaginal; Clinical Trials as Topic; Clotrimazole; Double-Blind Method; Drug Administration Schedule; Econazole; Female; Follow-Up Studies; Humans; Imidazoles; Miconazole; Nystatin; Pessaries; Recurrence; Vaginal Creams, Foams, and Jellies; Wales

Urinary tract infection (UTI) caused by Candida spp. is an increasing problem in clinical practice. Risk factors include diabetes mellitus, extremes of age, urinary tract abnormalities and indwelling catheters. Here, we determined the applicability of isothermal microcalorimetry (IMC) for the detection and antifungal drug susceptibility testing of Candida albicans in artificial urine.. Isothermal microcalorimetry was used to monitor the metabolic heat production rates of C. albicans at 37 °C (μW = μJ s(-1) ). The influence of increasing concentrations of glucose and antifungal drugs on the growth of C. albicans was investigated. The growth rate increased linearly from 0.024 ± 0.010 to 0.203 ± 0.006 h(-1) with increasing concentration of glucose from 20 to 1640 mg l(-1) . The minimum inhibitory concentrations (MIC) against C. albicans were determined at a fixed glucose concentration of 560 mg l(-1) . These MIC were 0.5 μg ml(-1) for amphotericin B, 5 μg ml(-1) for flucytosine, 0.8 μg ml(-1) for fluconazole and 0.5 μg ml(-1) for tioconazole, respectively.. IMC is able to detect and quantify growth of C. albicans in artificial urine and to determine the MIC of antifungal drugs against C. albicans. This study demonstrated that IMC can be used for basic research on Candida-UTI and opens promising avenue for the use of IMC as rapid drug resistance screening tool and diagnostic tool.. Little is known on the growth of C. albicans in urine. Our study provides measurements of the growth rate of this yeast in urine with various glucose concentrations. Thus, important insights are gathered for risk group such as patients with diabetes or patients with prolonged parenteral nutrition resulting in higher urinary glucose concentration.

Topics: Amphotericin B; Antifungal Agents; Calorimetry; Candida albicans; Fluconazole; Flucytosine; Glucose; Humans; Imidazoles; Microbial Sensitivity Tests; Urinary Tract Infections; Urine

In this paper the authors investigated a synergistic antimycotic effect between four antifungal drugs Amphotericin B, Fluconazole, Tioconazole, and Flucytosine individually combined with Anidulafungin compound. This latter is considered a drug of choice in the treatment of fungal infections; it has good activity both in vitro and in vivo against yeasts and moulds, as Candida and Aspergillus. The goal of this study was to evaluate the in vitro interaction of Anidulafungin in the synergic combinations with previous reported drugs against 12 Candida strains according to CLSI M27-A3 protocol. A synergistic interaction was observed against the most antifungal strains; in particular an increasing of the antimycotic efficacy was obtained from the association between Anidulafungin and Amphotericin B or Fluconazole (Mixture 4:6). In contrast the association Tioconazole/Anidulafungin was less effective on fungal species growth. The antimycotics MIC reduction values were more evident against some strains as C. glabrata, C. krusei, C. tropicalis and C. parapsilosis.

Topics: Amphotericin B; Anidulafungin; Antifungal Agents; Candida; Drug Synergism; Echinocandins; Fluconazole; Flucytosine; Imidazoles

Six azole-derivative antifungal compounds affected several aspects of Candida albicans hyphal development with only a relatively small degree of inhibition of growth rate, measured in terms of ATP concentration, whereas amphotericin B and 5-fluorocytosine affected morphology only when they also substantially inhibited fungal growth rate. At 10(-8) M, all the azoles tested inhibited branch formation by C. albicans hyphae. At 10(-7) M and higher concentrations, clotrimazole and miconazole strongly suppressed emergence of new hyphal outgrowths from parent yeast cells, whereas ICI 153066 and itraconazole had little effect on this phenomenon and ketoconazole and tioconazole had intermediate effects. At the highest concentrations tested (10(-5) M) hyphal development was ultimately arrested by the azole compounds and the fungus grew predominantly in the form of budding yeast cells; however, none of the azole antifungals prevented initial emergence of an apparently normal germ tube. The antifungals only exerted their morphological effects when they were present in the culture medium: removal of the compounds after exposure of C. albicans to them led to reversion to normal growth.

Topics: Amphotericin B; Antifungal Agents; Candida albicans; Clotrimazole; Flucytosine; Imidazoles; Itraconazole; Ketoconazole; Miconazole; Triazoles

Several antifungal agents, at concentrations of 10 micrograms/ml, were shown to suppress ATP concentrations very rapidly in intact cells and spheroplasts of Candida albicans. The highest ATP-suppressing activity was shown by the highly lipophilic imidazole derivatives difonazole, clotrimazole, econazole, isoconazole, miconazole, oxiconazole and tioconazole, which all caused a reduction of cellular ATP content of more than 50% in 10 min. Relatively hydrophilic imidazole derivatives such as ketoconazole were essentially inactive in the test, as were the triazole derivatives fluconazole, ICI 153066, itraconazole and terconazole, and 5-fluorocytosine. Amphotericin B and terbinafine possessed intermediate ATP-suppressing activity, and the dose-response and pH-response curves for these compounds suggested their mechanism of ATP suppression differed from that of the active imidazole derivatives. ATP suppression by azole antifungals did not involve leakage of ATP from the cells and the effect was entirely abrogated by the presence of serum. Intact cells and spheroplasts of yeast-form and hyphal-form C. albicans were generally equally sensitive to ATP suppression, but stationary-phase cells of both morphological forms were less sensitive than exponential-phase cells. The extent of ATP suppression was significantly reduced in stationary-phase yeast cells of a C. albicans strain with known resistance to azole antifungals, but exponential-phase cells of resistant and susceptible strains were equally sensitive. The effect is tentatively ascribed to membrane damage caused directly by the antifungals.

Topics: Adenosine Triphosphate; Amphotericin B; Antifungal Agents; Candida albicans; Depression, Chemical; Imidazoles; Ketoconazole; Miconazole; Naphthalenes; Terbinafine