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Background: Onychomycosis accounts for 20–40% of all nail disorders. It is difficult to cure with resistance to anti-fungal drugs, their side effects and drug interactions limiting treatment options. Itraconazole is a widely accepted oral medication used for onychomycosis while fractional CO2 laser along with a topical anti-fungal has shown promising results for nail plate clearance in onychomycosis. Aim: To compare the efficacy of fractional CO2 laser with 1% terbinafine cream versus itraconazole in the management of onychomycosis. Methods: A prospective, randomised, single-centre, two-arm, parallel-group interventional study was conducted at Command Hospital Air Force, Bangalore. Onychomycosis cases confirmed by KOH mount/culture-positive were included. Patients were randomly divided into two groups. Group A received 4 sessions of fractional CO2 laser every fourth week with twice-daily application of 1% terbinafine cream; Group B received one-week pulse therapy with capsule itraconazole once every four-week for three pulses. The response was assessed by Onychomycosis Severity Index, a validated onychomycosis assessment scale, at baseline and at six months. Results: Group A had 50 patients with a total of 98 nails. Clinical improvement was seen in 83/98 (84.7%) nails. The average reduction in Onychomycosis Severity Index was 8.65 (P < 0.05). Group B had 50 patients with a total of 136 nails. Clinical improvement was seen in 104/136 (76.5%) nails. The average reduction in Onychomycosis Severity Index was 7.37 (P < 0.05). Both groups showed statistically significant improvement measured by ‘Reduction in Onychomycosis Severity Index’ at six months; however, there was no significant difference between the two arms. Limitations: The main limitations of the study are the small sample size and lack of long-term follow-up to assess recurrence of infection. Conclusion: Fractional CO2 laser with 1% terbinafine cream is an effective and safe method for inducing nail clearance in onychomycosis and has efficacy similar to itraconazole pulse therapy.
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Objective:To compare the efficacy and safety of oral terbinafine versus itraconazole in the treatment of pediatric tinea capitis.Methods:From January 2021 to December 2021, a randomized clinical trial was conducted among 53 children with tinea capitis in Beijing Children′s Hospital. These patients were randomly divided into 2 groups by using a random number table: terbinafine group treated with oral terbinafine at different doses (weight <20 kg, dose: 62.5 mg/d; weight 20 - 40 kg, dose: 125 mg/d; weight >40 kg, dose: 250 mg/d), while itraconazole group treated with oral itraconazole at doses of 3 - 5 mg·kg -1·d -1. Statistical analysis was performed using the SPSS 23.0 software, and enumeration data were compared between groups by using chi-square test or Fisher′s exact test. Results:Totally, 27 patients were treated with oral terbinafine, including 17 with tinea alba and 10 with kerion; 26 were treated with oral itraconazole, including 17 with tinea alba and 9 with kerion. After treatment, 14 (51.85%) patients were cured in the terbinafine group, including 5 with tinea alba and 9 with kerion, while 25 (96.15%) were cured in the itraconazole group, including 16 with tinea alba and 9 with kerion. The response rate was significantly higher in the itraconazole group than in the terbinafine group ( χ2 = 13.37, P < 0.001) . Conclusion:The efficacy of itraconazole was superior to that of terbinafine in the treatment of pediatric tinea alba, but their efficacy was equivalent in the treatment of pediatric kerion.
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La terbinafina es un fármaco que puede inducir daño hepático agudo. Presentamos el caso de un paciente varón de 40 años que desarrolló disfunción hepática después de 35 días de tratamiento con terbinafina por onicomicosis. El estudio anátomo patológico demostró: hepatitis aguda en resolución, además de ductopenia y colestasis. Estos hallazgos, sin el antecedente de hepatitis viral o autoinmune, son consistentes con el diagnóstico de daño hepático inducido por drogas (DILI). En este reporte presentamos el primer caso en nuestro país de un paciente que es afectado por una enfermedad hepática aguda: injuria hepática inducida por terbinafina, al cual se le asoció posteriormente infección por SARS-CoV-2 en el contexto de una pandemia.
Terbinafine is a drug that can induce acute liver damage. We present the case of a 40-year-old male patient who developed liver dysfunction after 35 days of terbinafine treatment for onychomycosis. The anatomopathological study showed: acute hepatitis in resolution, in addition to ductopenia and cholestasis. These findings, without a history of viral or autoimmune hepatitis, are consistent with the diagnosis of drug-induced liver damage (DILI). In this report we present the first case in our country of a patient who is affected by an acute liver disease: terbinafine-induced liver injury, to which SARS-CoV-2 infection was later associated in the context of a pandemic.
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Resumen Objetivo: Analizar la susceptibilidad de N. dimidiatum ante el efecto combinado de itraconazol y terbinafina. Métodos: Se determinó la concentración mínima inhibitoria y la concentración inhibitoria fraccionada in vitro, mediante el método del tablero de ajedrez, a 15 aislamientos clínicos provenientes de onicomicosis de diferentes pacientes, todos positivos por N. dimidiatum. Se prepararon ensayos por duplicado con diluciones combinadas de los antifúngicos y se evaluó el efecto de ambos fármacos. Resultados: La concentración mínima inhibitoria promedio de solo itraconazol aplicado a los aislamientos fue de 30,83 μg/mL y de 4,49 μg/mL combinado con terbinafina. La concentración mínima inhibitoria promedio de solo terbinafina fue de 0,33 μg/mL y de 0,07 μg/mL combinada con itraconazol. Hay diferencias estadísticamente significativas entre las concentraciones mínimas inhibitorias promedio de los antifúngicos analizados en solitario respecto de las concentraciones mínimas inhibitorias combinadas; para itraconazol (t = 2,958; gl = 14; p = 0,01) y (t = 4,721; gl = 14; p < 0,001) para terbinafina. El uso combinado evidenció 40 % de sinergismo. Conclusiones: La combinación itraconazol-terbinafina presentó un efecto sinérgico total para inhibir el crecimiento de N. dimidiatum; esto ofrece una alternativa terapéutica en el tratamiento de las onicomicosis.
Abstract Aim: Study the combined susceptibility patterns of Neoscytalidium dimidiatum to the effect of Itraconazole and Terbinafine. Background: The Minimum Inhibitory Concentration and Fractional Inhibitory Concentration were determined in vitro by the chessboard method for 15 clinical isolates of onychomycosis, from different patients, all positives for N. dimidiatum. Duplicated trials were prepared with combined dilutions of antifungals and the effect of both drugs was evaluated. Results: The average Minimum Inhibitory Concentration of Itraconazole when applied alone for the isolates was 30.83 μg/mL and 4.49 μg/mL when combined with Terbinafine. The average Minimum Inhibitory Concentration of Terbinafine alone was 0.33 μg/mL and 0.07 μg/mL when combined with Itraconazole. Statistically significant differences were found between the average Minimum Inhibitory Concentrations of the antifungals analyzed alone versus the Minimum Inhibitory Concentrations obtained by mixing both compounds. That is for Itraconazole (t = 2,958; gl = 14; p = 0,01) and (t = 4,721; gl = 14; p <0,001) for Terbinafine. Combined use showed 40 % synergism. Conclusions: The Itraconazole-Terbinafine combination had synergistic effect to inhibit the growth of N. dimidiatum, which offers a therapeutic alternative in the treatment of onychomycoses caused by this fungus.
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Onychomycosis/drug therapy , Itraconazole/therapeutic use , Terbinafine/therapeutic use , Costa RicaABSTRACT
Objective To screen and identify the penetration enhancer in pharmacy prepared compound terbinafine ointment. Methods In vitro percutaneous penetration test was conducted with vertical Franz diffusion pool. The SD rat's abdomen skin was used for permeable membrane and 60% polyethylene glycol 400-40% saline for receiving liquid to analyze different osmotic promoters. Results The permeability of compound terbinafine ointment was significantly higher with 10% propylene glycol than 15% propylene glycol. The compound terbinafine ointment with 10% propylene glycol was also better than 3% azone in permeability. Conclusion 10% propylene glycol was selected to be the penetration promoter for pharmacy prepared compound terbinafine ointment, which improved the solubility of the drug in the skin.
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Objective To establish a method to assay 3 active components in pharmacy compounded terbinafine ointment simultaneously. Methods High performance liquid chromatography (HPLC) equipped with the ZORBAX SB-C8 (4.6 mm×250 mm, 5 μm) was used for the assay. The mobile phase was methanol-0.1% phosphoric acid (70∶30). The flow rate was 1.0 ml/min with the 248 nm detection wavelength, 10 μl injection volume and 30 ℃ column temperature. Results A good linear relationship was observed in the range of 20.4-204.0 µg/ml for terbinafine hydrochloride(r=0.999 7), 40.4-404.0 µg/ml for mupirocin(r=0.999 8), 2.02-20.20 µg/ml for mometasone furoate(r=0.999 7). The average recovery of each detected component in terbinafine ointment was 99.39%, 99.21%, 99.97% with the RSD 0.82%, 0.59%, 0.81%(n=9). Conclusion This method is simple, rapid and accurate. It can be used to detect the content of terbinafine, mupirocin and mometasone furoate in pharmacy compounded terbinafine ointment.
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Background: The objective of the present study was to compare the efficacy of terbinafine and griseofulvin in patients with tinea corporis in a tertiary care hospital, Madurai.Methods: About 60 patients are selected from the outpatient department of Dermatology according to inclusion and exclusion criteria. They were divided into 2 groups of 30 patients each. Group 1 received tab. terbinafine 250 mg OD and group 2 received 250 mg BD for 4 weeks. All patients were investigated at baseline, end of 2nd week and at end of 4 weeks. Effectiveness of both the drugs were determined by achieving clinical as well as mycological cure. The results were recorded, tabulated and analysed using student抯 t test.Results: Patients in group 1 showed higher clinical and mycological cure rate when compared with group 2.Conclusions: Oral terbinafine is the effective antifungal agent in the treatment of extensive tinea corporis infection.
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Objective: Solid lipid nanoparticles (SLNs) are at the forefront of the rapidly developing field of nanotechnology with several potential applications in drug delivery and research. The aim of this study was to develop and characterize SLNs formulae of Terbinafine HCl (TFH) for topical drug delivery applications. Methods: SLNs were prepared using the solvent injection technique. Glyceryl Monostearate (GMS) served as the lipid base. Three stabilizers; Tween 80, Cremophor RH40, and Poloxamer 188, were used. The effect of stabilizer type and concentration, as well as the lipid concentration, were studied, factorial design of 32*21was applied. The prepared SLNs were characterized regarding their particle size, zeta potential, polydispersity index (PDI), entrapment efficiency percent (EE %), and physicochemical stability. The selected formulae were subjected to further investigations such as morphological studies, in vitro release studies, and Infrared (IR) spectroscopy. They were compared with the marketed cream Lamifen® in term of their antifungal activity against Candida albicans. Results: Lipid concentration, together with the type and concentration of stabilizer, appeared to be the main cornerstones which affect the formation of SLNs. Smaller particle size was observed when increasing the stabilizer concentration and decreasing the lipid concentration. Higher EE% was observed when increasing both the stabilizer and the lipid concentrations. Formulae (F6, F12 andF19) were selected as the most suitable SLNs with optimum particle size of 480.2±18.89, 458.6±12.45 and 246.7±10.5 nm, respectively as well as the highest EE% of 87.13±0.19, 93.69±0.7 and 95.06±0.25, respectively. In vitro microbiological screening of their antifungal activity showed significantly larger zones of inhibition of diameters 25.9±0.25, 25±0.35 and 24.67±0.36 mm, respectively in comparison with the marketed Lamifen® cream which showed a zone of 11.2±0.44 mm diameter. Conclusion: Applying SLNs containing TFH as topical antifungal preparations may be considered as a very promising option as they show good physicochemical characterization with high antifungal activity, which delineates them as a promising dosage form for topical antifungal treatment.
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Background: In a hot and humid country like India, the prevalence of superficial mycotic infections is on the rise due to contributing environmental and demographic factors. In this study, we sought to assess the efficacies of two oral antifungal drugs, Itraconazole (a traditional azole) and Terbinafine (the only orally available allylamine). The two drugs were analyzed to see whether they differed significantly in their cure rates of tinea cruris. Since data, that compares only systemically administered Itraconazole and Terbinafine in the treatment of tinea cruris, is limited, this study becomes imperative.Methods: 60 patients, all clinically confirmed cases of tinea cruris and belonging to the age group of 18-65 years, were recruited for this prospective study. Patients were then randomly divided into groups A and B and followed-up for a month. Group A received cap. Itraconazole 100 mg, twice a day, for 15 days while group B received tab. Terbinafine 250 mg, once a day, for 4 weeks. Both groups were given topical 2% Sertaconazole that had to be continued for 8 weeks. During the 4 visits, scores for the 3 parameters (erythema, pruritis and scaling) were calculated and recorded for statistical analysis.Results: Authors observed that majority of the patients were exposed to hot and humid environment that contributed to sweating and poor personal hygiene. The changes in scores of erythema, pruritis and scaling from the baseline visit for both, Itraconazole and Terbinafine, were statistically significant at week 4 with P < 0.05 for all parameters. But the difference between the scores of the two drugs was not found to be statistically significant.Conclusions: Although the sample size of this study was small and the data was limited, findings of this study supported that both Itraconazole and Terbinafine were highly effective in the treatment of tinea cruris.
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Objectives: The study aimed at comparing the therapeuticefficacy of Terbinafine and Itraconazole in terms of clinical curein the treatment of Fluconazole resistant Tinea corporis andTinea cruris.Materials and Methods: A clinical trial with 154 patients’having Tinea corporis and Tinea cruris was performed. All thepatients were treated with fluconazole. The resistant patientswere randomly divided into two groups. The first group wastreated with Terbinafine 250mg daily for 4 weeks, whereassecond group was treated by Itraconazole for 4 weeks. Theparticipants were followed up till the end of treatment and onemonth after treatment.Results: At the end of the trial, terbinafine group developed78.84% clinical response, while Itraconazole treated groupdeveloped only 39.13%.Conclusion: Based on the marked observed difference, it maybe concluded that Terbinafine is more effective in treatingfluconazole resistant Tinea corporis and Tinea cruris.
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Background: There is a general impression among dermatologists in India that terbinafine has been losing its effectiveness in dermatophytoses over the past few years, but there are no recent data to support this. Aims: To determine the effectiveness of terbinafine in tinea corporis, tinea cruris and tinea faciei with a pragmatic prospective cohort study. Methods: A sample size of 361 patients was calculated taking a 5% margin of error and a 95% confidence level. Five hundred patients with tinea corporis, tinea cruris and tinea faciei confirmed by potassium hydroxide microscopy received oral terbinafine (5mg/kg/day) and topical terbinafine 1% applied twice daily for 4 weeks. Patients were evaluated at 2 and 4 weeks. Cure was defined as total clearance of lesions and negative microscopy. Results: Patients who came for follow-up at 2 and 4 weeks numbered 357 and 362 respectively. Ten patients were cured at 2 weeks (cure rate 2%, 95% confidence interval 1.0–3.7%, intention-to-treat analysis) and 153 patients were cured at 4 weeks (cure rate 30.6%, 95% confidence interval 26.7–34.8%). Limitations: Culture and antifungal susceptibility testing were not performed since this was a pragmatic study. There was also no follow up after completion of treatment to check for relapses, but the poor response makes this less relevant. Conclusion: The effectiveness of terbinafine in dermatophytosis was abysmal in this study.
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ABSTRACT Griseofulvin (GF) and terbinafine (TF) are commonly used drugs to treat dermatophytosis, a fungal infection of the skin. Today there is an increase in drug resistance to these antifungals which highlight the need for alternative synergistic therapies. Minimum Inhibitory Concentration (MIC) of GF and TF were determined against fungi clinical isolates from local hospitals with values ranging 0.03-2.0 µg mL-1 and 0.24-4.0 µg mL-1, respectively. A checkboard test was used to determine the combination of GF:TF which could induce an additive effect against the fungi isolates Multidrug-resistant isolates showed susceptibility after treatment with 16:2 µg mL-1 GF:TF. An MTT assay further verified that GF and TF combinations have greater additive effect against pathological and multidrug-resistant isolates than antifungals alone. Herein we disclose GF:TF combinations that could constitute as a possible new anti-dermatophyte therapy.
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In Vitro Techniques/methods , Drug Combinations , Griseofulvin/analysis , Tinea/pathology , Microbial Sensitivity Tests/instrumentation , Dermatomycoses/classification , Arthrodermataceae/classification , Antifungal Agents/analysisABSTRACT
Objective To observe the clinical efficacy of terbinafine in the treatment of complicated vulvovaginal candidiasis.MethodsA case of 100 patients with complicated vulvovaginal candidiasis treated in our hospital from January 2015 to December 2016, were randomly divided into treatment group (terbinafine) and the control group (fluconazole),each 50 cases,the treatment cycle is four weeks, the therapeutic effect of two groups was observed.ResultsIn the treatment group 45 cases cured, three cases were markedly effective, two cases effective, the total effective rate was 96%;In the control group 41 cases cured, three cases were markedly effective, six cases effective, the total effective rate was 88%.The difference between the two groups was statistically significant.(P<0.01).ConclusionTerbinafine treatment of complicated vulvovaginal candidiasis was significant.
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Objective To evaluate in vitro antifungal activity of tacrolimus combined with itraconazole or terbinafine against Exophiala dermatitidis (E.dermatitidis).Methods The minimum inhibitory concentrations (MICs) of itraconazole and terbinafine against 12 strains of E.dermatitidis were determined using the Clinical and Laboratory Standards Institute (CLSI) broth microdilution susceptibility method (M38-A2 Document).A broth microdilution checkerboard method was used to evaluate the in vitro antifungal activity of tacrolimus combined with itraconazole or terbinafine against E.dermatitidis.Results The MIC ranges of terbinafine and itraconazole against E.dermatitidis were 0.060-0.125 mg/L and 0.5-1 mg/L,respectively.The combination of tacrolimus with terbinafine showed synergistic inhibitory effects against 5 strains of E.dermatitidis,while the combination of tacrolimus with itraconazole revealed synergistic effects against 10 strains of E.dermatitidis.No antagonism was observed in either of the two combinations.Conclusion In vitro combination of tacrolimus with itraconazole or terbinafine can enhance the antifungal activity of itraconazole or terbinafine against E.dermatitidis.
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Background Macrogol 15 hydroxystearate (HS15) is a novel soft non-ionic surfactant and is widely used to solubilize the poorly soluble drugs due to high drug loading and enhancing permeability ability to hydrophobic drug.However,the delivering effects to cornea of HS15 on terbinafine hydrochloride (TH),a insoluble antifungal agents,is unclear.Objective This study was to investigate the promoting corneal absorption effects of HS15 micelles (HNMs) on TH.Methods TH-HNMs was prepared by a co-solvent method.The hydrodynamic droplet size,polydispersity index,and Zeta potential of TH-HNMs were measured by using a Zetasizer.The shape of the micelles was observed under the transmission electron microscope.The high performance liquid chromatography (HPLC) was employed to detect the in vitro cumulative releasing level of TH in the TH-HNMs and drug entrapment efficiency.TH-HNMs was topically adninistered in eyes of 5 healthy male New Zealand rabbits to evaluate the ocular irritation response.Ninety rabbits were randomized into experimental group and control group,and 50 μl of 0.5％ TH-HNMs and 0.5％ oily TH were topically administered in the right eyes of the animals in the experimental group and contral group,respectively.The animals were sacrificed 5,15,30,60,90,120,180,240,360 minutes after eye dropping by over anesthetization way and the corneas were harvested,and the TH content in the cornea was detected using HPLC.The study protocal was approved by Life Science Ethic Committee of Henen Eye Hospital.Results The average size and polyolis persital index of TH-HNMs were 13.32 nm and 0.046,respectively,and its average Zeta potential was-0.133 mV.The drug entrapment efficiency was 100％.The release level of TH from the micelles presented a pH-dependent manner.The release level of TH was (95.20±3.20)％ in the phosphate buffer with pH 5.0 and (0.17± 0.01)％ in the phosphate buffer with pH 7.4.The ocular irritation score was 2,and no visible damage was found around experimental eyes after instillation of TH-HNMs.The peak content of TH in the rabbit cornea 5 minutes was (20.26±2.26)pg/g in the experimental group,which was significantly higher than (1.40± 0.44)μg/g in the control group (t =18.926,P=0.000).The area under the curve (AUC)0.360min of drug concentration-time curve in the experimental group was 1 292.25 μg/(g · min),which was 15.6 times more than the control group.Conclusions TH-HNMs is an ideal agent with a simple preparing process,high drug entrapment efficiency,small size and low ocular irritation.Compared with oily TH,TH-HNMs can effectively enhance the corneal absorption of TH.
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BACKGROUND: Malasseiza species are dimorphic and lipophilic fungi which are part of normal mycota of the human skin, and also associated with some skin diseases. In many skin diseases such as pityriasis versicolor, Malassezia folliculitis, seborrheic dermatitis, atopic dermatitis and psoriasis, Malassezia yeasts may have a key role. OBJECTIVE: To investigate susceptibility of antifungal agent including itraconazole, fluconazole and terbinafine, we conducted in vitro susceptibility test revealing minimum inhibitory concentration of drugs for each Malassezia strains. METHODS: Malassezia restricta CBS7877, M. globosa CBS 7966, M. slooffiae KCTC 27517, M. sympodialis CBS 7222, M. pachydermatis CBS 1879 and M. furfur CBS 1878 were used in this experiment. The strains were grown in Leeming and Notman medium. MIC was determined using the method suggested by Sugita, et al. with modification. Malassezia cells were grown in each well and incubated for 2 days at 34℃, and MIC was determined by agar dilution method. RESULTS: Most Malasseiza strains of all Malassezia species were most sensitive to itraconazole, with MICs ranging from 0.015 to 0.06 µg/mL. MIC values of fluconazole and terbinafine against Malassezia species were higher and wider range than MIC of itraconazole. CONCLUSION: Itracozanole would be the first choice drug for treatment of Malassezia associated skin diseases. Isolation of pathologic species of Malassezia from various skin diseases in Korea would be fundamental research for the target therapy, and drug susceptibility test would be helpful for proper treatment.
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Humans , Agar , Dermatitis, Atopic , Dermatitis, Seborrheic , Fluconazole , Folliculitis , Fungi , In Vitro Techniques , Itraconazole , Korea , Malassezia , Methods , Microbial Sensitivity Tests , Psoriasis , Skin , Skin Diseases , Tinea Versicolor , YeastsABSTRACT
Abstract Tinea faciei is a relatively uncommon dermatophyte infection entailing atypical clinical symptoms, usually misdiagnosed and treated with corticosteroids. The authors describe a case of tinea faciei on the right eyebrow caused by Trichophyton interdigitale. The patient was an 18-year-old girl, who had an inflammatory plaque with a scaly, pustular surface on the right eyebrow and upper eyelid, which had persisted for over 1 month. She was once misdiagnosed as having eczema and was treated using corticosteroid cream. A diagnosis of tinea faciei was made based on direct microscopy and culture. The sequencing of the nuclear ribosomal ITS region and β-tubulin gene of the isolate established its T. interdigitale lineage. The patient was cured by treatment with systemic terbinafine in combination with topical application of 1% naftifine-0.25% ketaconazole cream for 2 weeks.
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Humans , Female , Adolescent , Tinea/pathology , Trichophyton/isolation & purification , Eyebrows/microbiology , Eyebrows/pathology , Facial Dermatoses/microbiology , Facial Dermatoses/pathology , Tinea/drug therapy , Urease/analysis , Microscopy, Electron, Scanning , Treatment Outcome , Dermoscopy , Facial Dermatoses/drug therapy , Antifungal Agents/therapeutic use , Naphthalenes/therapeutic useABSTRACT
Onychomycosis is a common disease that requires appropriate management. Systemic antifungal agents are current standard for onychomycosis treatment. Considering high recurrence rate, selection of the systemic antifungal agent should be based primarily on the causative organism, the potential adverse effects and the risk of drug interactions. Herein, we reviewed systemic antifungal agent for onychomycosis.
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Antifungal Agents , Drug Interactions , Fluconazole , Itraconazole , Onychomycosis , RecurrenceABSTRACT
Background: This study aimed to determine the minimum inhibitory concentrations (MICs) of various antifungal agents against moulds isolated from dermatological specimens. Methods: We identified 29 moulds from dermatological specimens between October 2012 and March 2013 by conventional methods. We performed antifungal susceptibility testing on six antifungal agents, amphotericin B, clotrimazole, itraconazole, ketoconazole, miconazole and terbinafine, according to the Clinical and Laboratory Standards Institute guidelines contained in the M38-A2 document. Results: Most antifungal agents were active against the dermatophytes, except for terbinafine against Trichophyton rubrum (geometric mean MIC, MICGM 3.17 µg/mL). The dematiaceous moulds were relatively susceptible to amphotericin B and azoles (MICGM 0.17-0.34 µg/mL), but not to terbinafine (MICGM 3.62 µg/mL). Septate hyaline moulds showed variable results between the relatively more susceptible Aspergillus spp. (MICGM 0.25-4 µg/mL) and the more resistant Fusarium spp. (MICGM 5.66-32 µg/mL). The zygomycetes were susceptible to amphotericin B (MICGM 0.5 µg/mL) and clotrimazole (MICGM 0.08 µg/mL), but not to other azoles (MICGM 2.52-4 µg/mL). Conclusion: Amphotericin B and clotrimazole were the most effective antifungal agents against all moulds excepting Fusarium spp., while terbinafine was useful against dermatophytes (except T. rubrum) and Aspergillus spp. However, a larger study is required to draw more solid conclusions.
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Scedosporium prolificans have been reported to be resistant to all antifungals including the newer azoles and echinocandins. We report an unusual case of repeated S. prolificans infection of the heart valves in an immunocompetent patient.