Time-Kill Kinetics of Rezafungin (CD101) in Vagina-Simulative Medium for Fluconazole-Susceptible and Fluconazole-ResistantCandida albicansand Non-albicans CandidaSpecies
Background.While echinocandins demonstrate excellent efficacy againstCandidaspecies in disseminated infections and demonstrate potent minimal inhibitory concentration (MIC) values under standard susceptibility testing conditions, investigation under conditions relevant to the vaginal environment was needed. We assessed the antifungal activity and time-kill kinetics of the novel echinocandin rezafungin (formerly CD101) under such conditions, againstCandidaspecies relevant to vulvovaginal candidiasis (VVC).Methods. Susceptibility testing of fluconazole-susceptible and fluconazole-resistantC. albicans,C. glabrata,C. tropicalis,C. parapsilosis, andC. kruseiwas performed in RPMI at pH 7.0 and in vagina-simulative medium (VSM) at pH 4.2 for topical rezafungin, terconazole, fluconazole, and amphotericin B. Time-kill kinetics were evaluated for rezafungin and terconazole at 2, 8, 32, and 128 μg/ml over 72 hours.Results.Rezafungin MIC values were the same or 2-fold higher in VSM/pH 4.2 versus RPMI/pH 7.0. SomeC. albicansterconazole MIC values were lower, but most were significantly higher in VSM than in RPMI. Rezafungin was fungicidal against 11/14 strains and near-fungicidal against the others. Terconazole (128 μg/ml) was fungicidal againstC. kruseiand near-fungicidal against susceptibleC. parapsilosisbut fungistatic versus all other strains evaluated.Conclusion.Rezafungin retained anti-Candidaactivity and fungicidal activity under in vitro conditions relevant to VVC.