Treatment of Azole-Resistant Oropharyngeal Candidiasis with Topical Amphotericin B

2002 ◽  
Vol 36 (9) ◽  
pp. 1383-1386 ◽  
Author(s):  
Shellee A Grim ◽  
Kelly M Smith ◽  
Frank Romanelli ◽  
Ighovwerha Ofotokun
Keyword(s):  
Amphotericin B ◽  
Oral Candidiasis ◽  
Symptomatic Improvement ◽  
Oropharyngeal Candidiasis ◽  
Double Blind ◽  
In Vitro Susceptibility ◽  
Product Formulation ◽  
Patient Reported ◽  
Susceptibility Tests

OBJECTIVE: To report a case of successful treatment of azole-refractory oropharyngeal candidiasis with topical amphotericin B. CASE SUMMARY: A 30-year-old white woman presented with recurrent oral thrush. The patient had been exposed to azole antifungals for >20 years, and in vitro susceptibility tests revealed class resistance. The patient started taking amphotericin B 100 mg oral suspension swish-and-spit 4 × daily. After 4 weeks of topical amphotericin B treatment, the patient reported significant symptomatic improvement. The oral candidiasis worsened following a course of oral antibiotics, but improved once the antibiotic was discontinued and after receiving amphotericin B swish-and-swallow for 4 additional weeks. DISCUSSION: Current Infectious Diseases Society of America guidelines include topical amphotericin B as a potentially effective option for the treatment of oropharyngeal candidiasis. There is limited evidence to support this recommendation. Besides lack of data, an appropriate dosing regimen and consistent means of product formulation need to be determined. CONCLUSIONS: This report demonstrates the potential role for topical amphotericin B in the treatment of azole-refractory oral candidiasis. Double-blind, randomized, controlled trials are needed to define dosing, efficacy, administration, and long-term safety of oral amphotericin B.

Antifungal susceptibility of bloodstream yeasts isolated at a public children’s hospital in Brazil: comparison of the Etest® and the AFST–EUCAST microdilution method

2007 ◽  
Vol 53 (12) ◽  
pp. 1300-1306 ◽  
Author(s):  
Flávia E. Matsumoto ◽  
Amanda L.T. Dias ◽  
Márcia S.C. Melhem ◽  
Maria W. Szeszs ◽  
Marcos E. Auler ◽  
...  
Keyword(s):  
Amphotericin B ◽  
Susceptibility Testing ◽  
Antifungal Susceptibility ◽  
Candida Spp ◽  
In Vitro Susceptibility ◽  
Microdilution Method ◽  
Susceptibility Tests ◽  
Susceptibility Profiles

This study compared the minimum inhibitory concentration (MIC) results from the proposed standard methods of the Antifungal Susceptibility Testing Subcommittee of the European Committee on Antibiotic Susceptibility Testing (AFST–EUCAST) with the commercial system Etest® in the evaluation of susceptibility to flucytosine, fluconazole, itraconazole, voriconazole, and amphotericin B of 136 Candida spp. isolated from the blood of hospitalized children. The results presented a greater agreement among Etest® MICs ±2 log2 dilutions of AFST–EUCAST for fluconazole (98.1% and 96.3%) and voriconazole (100% and 100%) for Candida albicans and Candida parapsilosis . For Candida glabrata , the agreement was greater only for fluconazole (81.8%) and voriconazole (100%). For amphotericin B, the agreement between the methods was low for all species. The agreement percentage among the Etest® and AFST–EUCAST susceptibility profiles was high according to the MIC breakpoints recommended by the M27-A2 protocol for the majority of the yeasts, except for fluconazole and itraconazole against Candida tropicalis and for itraconazole against C. glabrata and Candida krusei . According to both methodologies, a great number of Candida spp. isolates showed an in vitro susceptibility to all evaluated antifungal agents. Overall, both procedures can be reliable techniques for susceptibility tests of yeasts, but the assessment of interlaboratory agreement and correlation of MICs by different methods with in vivo response are of great importance.

scholarly journals Isolation of Candida africana in oral candidiasis: First report among cancer patients in Iran

2020 ◽  
Author(s):  
Ensieh Lotfali ◽  
Masoud Mardani ◽  
Sara Abolghasemi ◽  
David Darvishnia ◽  
Mohammad Mahdi Rabiei ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Amphotericin B ◽  
Oral Candidiasis ◽  
Antifungal Susceptibility ◽  
Empirical Therapy ◽  
Antifungal Prophylaxis ◽  
In Vitro Susceptibility ◽  
Molecular Tests ◽  
In Vitro Antifungal Susceptibility

Background and Purpose: Oropharyngeal candidiasis (OPC) is a fungal infection of the oral cavity caused by the members of C. albicans complex. Although C. africana, as a part of the complex, is considered to be mostly responsible for the development of vulvovaginal candidiasis, it may be associated with a wider clinical spectrum. Case report: This report described two cases diagnosed with oral candidiasis during the receipt of treatment for malignancies. Conventional and molecular tests were performed on the samples collected from the patients’ oral cavities. The test results revealed C. africana as the causative agent of oral candidiasis. Furthermore, in vitro antifungal susceptibility test indicated the full susceptibility of all C. africana isolates to caspofungin. However, the data were also suggestive of the resistance against fluconazole and amphotericin B. Caspofungin was used as the main antifungal agent for the treatment of oral candidiasis, resulting in the improvement of thrush in patients. The resistance of C. africana to fluconazole and amphotericin B suggests the necessity of performing in vitro susceptibility testing on the isolates for the selection of appropriate antifungal agents. Conclusion: As the findings indicated, the achievement of knowledge regarding C. africana as an emerging non-albicans Candida species and its antifungal susceptibility profile is crucial to select antifungal prophylaxis and empirical therapy for oral candidiasis in cancer patients undergoing chemotherapy.

Prolonged Pneumococcal Meningitis Due to an Organism With Increased Resistance to Penicillin

PEDIATRICS ◽  
1976 ◽  
Vol 58 (3) ◽  
pp. 378-381 ◽  
Author(s):  
Abel Paredes ◽  
Larry H. Taber ◽  
Martha D. Yow ◽  
Dorothy Clark ◽  
William Nathan
Keyword(s):  
Case Report ◽  
Streptococcus Pneumoniae ◽  
Pneumococcal Meningitis ◽  
Pneumococcal Infections ◽  
In Vitro Susceptibility ◽  
Focus Of Infection ◽  
Resistance To Penicillin ◽  
Penicillin Treatment ◽  
Susceptibility Tests

For more than 30 years, penicillin has been the agent of choice for pneumococcal infections. During this time the majority of strains of Streptococcus pneumoniae have been highly susceptible to penicillin. However, during the last ten years there have been sporadic reports of pneumococci with increased resistance to penicillin. The case report of an 18-month-old white boy with meningitis due to a strain of S. pneumoniae with increased resistance to penicillin is presented. The MIC of the organism to penicillin was 0.2µg/ml and the MBC 0.39µg/ml. The patient had normal immunity and no demonstrable sequestered focus of infection but failed to respond to appropriate doses of intravenous penicillin. Treatment with chloramphenicol caused a dramatic bacteriologic and clinical response. This experience reemphasizes the existence of pneumococcal strains of intermediate penicillin sensitivity and the importance of in vitro susceptibility tests.

Assessment of Laboratory Performance With Streptococcus pneumoniae Antimicrobial Susceptibility Testing in the United States

1999 ◽  
Vol 123 (4) ◽  
pp. 285-289 ◽  
Author(s):  
Gary V. Doern ◽  
Angela B. Brueggemann ◽  
Michael A. Pfaller ◽  
Ronald N. Jones
Keyword(s):  
United States ◽  
Streptococcus Pneumoniae ◽  
Antimicrobial Agents ◽  
Susceptibility Testing ◽  
Clinical Laboratory ◽  
The United States ◽  
National Committee ◽  
In Vitro Susceptibility ◽  
Susceptibility Tests

Abstract Objective.—To assess the performance of clinical microbiology laboratories in the United States when conducting in vitro susceptibility tests with Streptococcus pneumoniae. Methods.—The results of a nationwide College of American Pathologists Proficiency Survey test sample, in which susceptibility testing of an isolate of S pneumoniae was performed, were assessed with respect to precision and accuracy. Results.—Wide variability was noted among participating laboratories with both minimum inhibitory concentration procedures and disk diffusion susceptibility tests when both methods were applied to S pneumoniae. Despite this high degree of variation, categorical interpretive errors were uncommon. Numerous laboratories reported results for antimicrobial agents that are not recommended by the National Committee for Clinical Laboratory Standards for tests with S pneumoniae. Conclusions.—Current susceptibility testing practices with S pneumoniae in the United States indicate limited precision and a tendency for laboratories to test and report results obtained with antimicrobial agents of questionable therapeutic value against this organism. Continued efforts to standardize susceptibility testing of S pneumoniae in the United States are warranted. In addition, modifications of existing interpretive criteria may be necessary.

LABORATORY ASPECTS OF ANTIBIOTIC THERAPY

PEDIATRICS ◽  
1951 ◽  
Vol 8 (3) ◽  
pp. 406-412
Author(s):  
EARLE H. SPAULDING
Keyword(s):  
Antibiotic Therapy ◽  
Single Species ◽  
Clinical Results ◽  
Bacterial Strains ◽  
In Vitro Susceptibility ◽  
Bacterial Cultures ◽  
Susceptibility Tests ◽  
And Control ◽  
Susceptibility Patterns

Bacterial strains within a single species exhibit highly specific susceptibility patterns when tested with the several antibiotics currently available. Because in vitro susceptibility tests constitute the only certain method for predicting clinical response, the bacteriology laboratory is playing an expanding part in the choice and control of antibiotic therapy. Although there is no need for bacteriologic studies in the vast majority of infections, they are sometimes essential to the successful management of severe acute, refractory and relapsing infections. The correlation between laboratory and clinical results is good providing allowances are made for certain factors discussed in this paper. Antibiotic susceptibility tests are entirely practical and should be used routinely in all laboratories which do bacterial cultures.

Stable Phenotypic Resistance of CandidaSpecies to Amphotericin B Conferred by Preexposure to Subinhibitory Levels of Azoles

1998 ◽  
Vol 36 (9) ◽  
pp. 2690-2695 ◽  
Author(s):  
Jose A. Vazquez ◽  
Maria T. Arganoza ◽  
Dina Boikov ◽  
Stephanie Yoon ◽  
Jack D. Sobel ◽  
...  
Keyword(s):  
Amphotericin B ◽  
Clinical Setting ◽  
Fungicidal Activity ◽  
No Reduction ◽  
Growth Conditions ◽  
In Vitro Assays ◽  
In Vitro Susceptibility ◽  
Phenotypic Resistance ◽  
Time Period

The fungicidal activity of amphotericin B (AmB) was quantitated for several Candida species. Candida albicans andC. tropicalis were consistently susceptible to AmB, with less than 1% survivors after 6 h of exposure to AmB. C. parapsilosis and variants of C. lusitaniae andC. guilliermondii were the most resistant, demonstrating 50 to 90% survivors in this time period and as high as 1% survival after a 24-h exposure time. All Candida species were killed (<1% survivors) after 24 h of exposure to AmB. In contrast, overnight exposure to either fluconazole or itraconazole resulted in pronounced increases in resistance to subsequent exposures to AmB. Most dramatically, C. albicans was able to grow in AmB cultures after azole preexposure. Several other Candida species did not grow in AmB but showed little or no reduction in viability after up to 24 h in AmB. Depending on the growth conditions,Candida cells preexposed to azoles may retain AmB resistance for days after the azoles have been removed. If this in vitro antagonism applies to the clinical setting, treatment of patients with certain antifungal combinations may not be beneficial. The ability of some Candida isolates to survive transient exposures to AmB was not reflected in the in vitro susceptibility changes as measured by standard MIC assays. This finding should be considered in studies attempting to correlate patient outcome with in vitro susceptibilities of clinical fungal isolates. Patients who fail to respond to AmB may be infected with isolates that are classified as susceptible by standard in vitro assays but that may be resistant to transient antifungal exposures which may be more relevant in the clinical setting.

scholarly journals In Vitro Susceptibility of Mycobacterium abscessus and Mycobacterium fortuitum Isolates to 30 Antibiotics

2018 ◽  
Vol 2018 ◽  
pp. 1-10 ◽  
Author(s):  
Yaojie Shen ◽  
Xuyang Wang ◽  
Jialin Jin ◽  
Jing Wu ◽  
Xuelian Zhang ◽  
...  
Keyword(s):  
Public Health Problem ◽  
Drug Susceptibility ◽  
Mycobacterium Abscessus ◽  
Mycobacterium Fortuitum ◽  
In Vitro Susceptibility ◽  
Antitubercular Drugs ◽  
Microdilution Method ◽  
Susceptibility Tests ◽  
Susceptibility Profiles

Objective. Nontuberculous mycobacteria (NTM) cause various diseases in humans and animals. Recently, the prevalence of NTM-related disease has been on the rise, becoming an emerging public health problem. The aim of this study was to determine the antibiotic susceptibility profiles of clinical isolates of Mycobacterium abscessus and Mycobacterium fortuitum. Methods. We performed susceptibility tests on 37 clinical NTM isolates to 30 antibiotics with the microdilution method recommended by the Clinical and Laboratory Standards Institute. Results. Both M. abscessus and M. fortuitum were highly resistant to antitubercular drugs such as isoniazid, rifampin, ethambutol, clofazimine, ethionamide, and rifabutin. M. abscessus showed the lowest resistant rates to cefoxitin (10%), azithromycin (10%), amikacin (10%), and clarithromycin (20%) and very high resistant to sulfamethoxazole, vancomycin, oxacillin, clindamycin, and all fluoroquinolones. M. fortuitum showed low resistance to tigecycline (0%), tetracycline (0%), cefmetazole (12%), imipenem (12%), linezolid (18%), and the aminoglycosides amikacin (0%), tobramycin (0%), neomycin (0%), and gentamycin (24%). Conclusion. Amikacin, cefoxitin, and azithromycin have the highest in vitro activity against M. abscessus. Isolates of M. fortuitum need to be individually evaluated for drug susceptibility before choosing an effective antimicrobial regimen for treatment of infections.

scholarly journals Evaluation of the Effectiveness of Crotoxin as an Antiseptic against Candida spp. Biofilms

Toxins ◽  
2020 ◽  
Vol 12 (9) ◽  
pp. 532
Author(s):  
Amanda Pissinatti Canelli ◽  
Taís Fernanda dos Santos Rodrigues ◽  
Vivian Fernandes Furletti de Goes ◽  
Guilherme Ferreira Caetano ◽  
Maurício Ventura Mazzi
Keyword(s):  
Biofilm Formation ◽  
Colorimetric Assay ◽  
Oral Candidiasis ◽  
Hacat Cells ◽  
Candida Spp ◽  
Oral Infections ◽  
Minimum Fungicidal Concentration ◽  
Antimicrobial Susceptibility Tests ◽  
Susceptibility Tests

The growing number of oral infections caused by the Candida species are becoming harder to treat as the commonly used antibiotics become less effective. This drawback has led to the search for alternative strategies of treatment, which include the use of antifungal molecules derived from natural products. Herein, crotoxin (CTX), the main toxin of Crotalus durissus terrificus venom, was challenged against Candida tropicalis (CBS94) and Candida dubliniensis (CBS7987) strains by in vitro antimicrobial susceptibility tests. Minimum inhibitory concentration (MIC), minimum fungicidal concentration (MFC), and inhibition of biofilm formation were evaluated after CTX treatment. In addition, CTX-induced cytotoxicity in HaCaT cells was assessed by MTT (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide) colorimetric assay. Native CTX showed a higher antimicrobial activity (MIC = 47 μg/mL) when compared to CTX-containing mouthwash (MIC = 750 μg/mL) and nystatin (MIC = 375 μg/mL). Candida spp biofilm formation was more sensitive to both CTX and CTX-containing mouthwash (IC100 = 12 μg/mL) when compared to nystatin (IC100 > 47 μg/mL). Moreover, significant membrane permeabilization at concentrations of 1.5 and 47 µg/mL was observed. Native CTX was less cytotoxic to HaCaT cells than CTX-containing mouthwash or nystatin between 24 and 48 h. These preliminary findings highlight the potential use of CTX in the treatment of oral candidiasis caused by resistant strains.

Sign in / Sign up

Export Citation Format

Share Document