title: Alternatives to amphotericin B for Candida rugosa infection.
abstract: OBJECTIVE
  Amphotericin B failure is frequently seen in patients with candidaemia caused by Candida rugosa. We evaluated amphotericin B, fluconazole, posaconazole and voriconazole as alternative treatments against infection in mice with two isolates of C. rugosa.
  
  
  METHODS
  Neutropenic mice were inoculated intravenously with C. rugosa. Amphotericin B, fluconazole, posaconazole and voriconazole were administered for 7 days after infection. Efficacy of the antifungal treatment was assessed by survival and tissue burden of C. rugosa.
  
  
  RESULTS
  All of the four drugs significantly prolonged survival over controls. With both isolates, kidney counts were reduced significantly below controls for amphotericin B, fluconazole and posaconazole. However, voriconazole was less effective than the other antifungals.
  
  
  CONCLUSIONS
  Despite poor clinical response to amphotericin B, in vivo data indicate that amphotericin B increases organ clearance and survival over untreated controls. However, although voriconazole improved survival over controls, increased tissue clearance was not seen. This discrepancy may be caused by rapid clearance of voriconazole in mice. These studies suggest fluconazole, posaconazole or voriconazole may be useful alternatives to amphotericin B in therapy of C. rugosa infection.
authors.affiliation: Department of Medicine, Division of Infectious Diseases, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229-3900, USA. Hernandezs@uthscsa.edu
authors.forename: Steve
authors.initials: S
authors.lastname: Hernandez
authors.forename: Gloria M
authors.initials: GM
authors.lastname: Gonzalez
authors.forename: Dora I
authors.initials: DI
authors.lastname: McCarthy
authors.forename: Arnaldo Lopes
authors.initials: AL
authors.lastname: Colombo
authors.forename: Laura K
authors.initials: LK
authors.lastname: Najvar
authors.forename: Rosie
authors.initials: R
authors.lastname: Bocanegera
authors.forename: John R
authors.initials: JR
authors.lastname: Graybill
mesh_terms: D000666:Amphotericin B / Q000627:therapeutic use*; D000818:Animals; D000935:Antifungal Agents / Q000627:therapeutic use*; D002177:Candidiasis / Q000188:drug therapy* / Q000382:microbiology; D015169:Colony Count, Microbial; D015725:Fluconazole / Q000627:therapeutic use; D007668:Kidney / Q000382:microbiology; D008297:Male; D051379:Mice; D008813:Mice, Inbred ICR; D008826:Microbial Sensitivity Tests; D009503:Neutropenia / Q000382:microbiology; D009929:Organ Size; D011743:Pyrimidines / Q000627:therapeutic use; D013154:Spleen / Q000382:microbiology; D016019:Survival Analysis; D014230:Triazoles / Q000627:therapeutic use; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; C101425:posaconazole; D000666:Amphotericin B; D015725:Fluconazole; D065819:Voriconazole