title: Does the addition of nystatin to 5% mafenide acetate and genitourinary irrigant solutions interfere with their antimicrobial activity? Assessment by two topical antimicrobial test assay systems.
abstract: Results previously reported using the Wet Disc Topical Antimicrobial Assay (WDA) suggested that adding nystatin (NY) to a 0.5% mafenide acetate (MA) suspension or genitourinary irrigant (double antibiotic [DAB]) to expand their antimicrobial activity to include Candida sp. antagonized the antibacterial effect of MA but not DAB. We use DAB solution as described by the authors of the previous study, also, but we use a 5% commercially available mafenide acetate solution instead of the in-house prepared 0.5% mafenide acetate suspension that they used. Further, we use both the WDA and the Agar Well Diffusion Topical Antimicrobial Assay (AWDA) to test topical antimicrobials at this institution. In light of the previously reported results, this study 1) examined whether adding nystatin to DAB or the 5% mafenide acetate solution used at this institution caused any interference in the ability of these substances to migrate through the agar matrices and cause zones of growth inhibition in the two test assay systems and 2) compared the assessment of microbial susceptibility (by very precise definition) between the two systems. The addition of nystatin did not interfere with the ability of either DAB or mafenide acetate to migrate through the agar matrices and cause clear zones. However, on the assessment of susceptibility a significantly larger number of organisms were judged susceptible using the AWDA than the WDA. We believe that the disparity is caused by a large difference in agar diffusion kinetics between the two assays. Therefore, we recommend the AWDA rather than the WDA for susceptibility studies.
authors.affiliation: Shriners Hospitals for Children, Cincinnati, Ohio, 45229, USA.
authors.forename: I A
authors.initials: IA
authors.lastname: Holder
authors.forename: A N
authors.initials: AN
authors.lastname: Neely
mesh_terms: D000287:Administration, Topical; D000362:Agar; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002177:Candidiasis / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D052776:Female Urogenital Diseases / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D066298:In Vitro Techniques; D008272:Mafenide / Q000008:administration & dosage / Q000627:therapeutic use*; D052801:Male Urogenital Diseases; D008826:Microbial Sensitivity Tests; D009761:Nystatin / Q000008:administration & dosage / Q000627:therapeutic use*; D007507:Therapeutic Irrigation
chemical_list: D000891:Anti-Infective Agents, Local; D000935:Antifungal Agents; D009761:Nystatin; D008272:Mafenide; D000362:Agar