Synergistic action of amphotericin B and rifampin against Rhizopus species.
A 16-year-old diabetic patient developed Rhizopus pneumonia and was initially treated with amphotericin B for 7 days. Because of clinical deterioration of the patient, rifampin was added empirically. The patient improved clinically, and lung tissue removed surgically 8 weeks later showed no fungal elements by histopathological studies or by culture. An in vitro study of amphotericin B alone and in combination with rifampin against the isolate from the patient and 11 additional isolates of Rhizopus spp. was designed. The activity of amphotericin B in the presence of rifampin (10 or 5 micrograms/ml) increased fourfold against 9 of 10 clinical and 1 of 2 environmental isolates. Amphotericin B activity in the presence of 2 micrograms of rifampin per ml increased fourfold against 6 of 10 clinical isolates and increased twofold against an additional 3 clinical isolates. Amphotericin B in the presence of 1 microgram of rifampin per ml inhibited 9 of 10 isolates at a concentration of one-half the MIC of amphotericin B alone. These findings were confirmed by dose-response curves calculated from fungal dry weight determinations of Rhizopus spp. incubated in serial dilutions of amphotericin B combined with rifampin. These observations demonstrate in vitro, and possibly in vivo, synergy between amphotericin B and rifampin against Rhizopus spp.
University of Oklahoma Health Sciences Center, Division of Pediatric Infectious Diseases, Oklahoma City 73190.
J C
JC
Christenson
I
I
Shalit
D F
DF
Welch
A
A
Guruswamy
M I
MI
Marks
D000293:Adolescent; D000666:Amphotericin B / Q000494:pharmacology*; D004305:Dose-Response Relationship, Drug; D004357:Drug Synergism; D005260:Female; D006801:Humans; D008826:Microbial Sensitivity Tests; D012233:Rhizopus / Q000187:drug effects*; D012293:Rifampin / Q000494:pharmacology*
D000666:Amphotericin B; D012293:Rifampin