title: In vitro activity of fluconazole, itraconazole, voriconazole and terbinafine against fungi causing onychomycosis.
abstract: BACKGROUND
  Onychomycosis is one of the commonest dermatological diseases worldwide. The antifungal activity of current medications varies, and treatment failure occurs in 25-40% of treated patients.
  
  
  OBJECTIVE
  To evaluate the in vitro antifungal activity of itraconazole, fluconazole, terbinafine and voriconazole against isolates taken from patients with onychomycosis.
  
  
  METHODS
  Nail isolates were evaluated according to methods described in the protocols of the Antifungal Susceptibility Testing Subcommittee of the European Committee on Antimicrobial Susceptibility Testing (AFST-EUCAST) and the Clinical and Laboratory Standards Institute (CLS M38-A), and a CLSI M38-A modified technique for dermatophytes. Antifungal agents tested included terbinafine, itraconazole, voriconazole and fluconazole.
  
  
  RESULTS
  In total, 103 isolates of Candida species (n = 58), Fusarium species (n = 10), Fusicoccum dimidiatum (n = 4), Scytalidium hyalinum (n = 1) and dermatophytes (n = 30) were evaluated. Itraconazole and voriconazole were the most active agents against Candida species, whereas terbinafine and voriconazole were most potent against dermatophytes. Fusarium species had the highest minimum inhibitory concentration (MIC) values with all antifungal agents.
  
  
  CONCLUSIONS
  The aetiological agents of onychomycosis that we found differ from those found in other countries, suggesting that the heat and humidity of the Colombian climate could favour yeast nail infections. The lowest MICs for Candida species (obtained with voriconazole, followed by itraconazole) may be explained by emerging resistant strains. Against dermatophytes, the lowest MICs were obtained with terbinafine, followed by voriconazole. MIC values for the evaluated agents were higher for non-dermatophyte filamentous fungi than for other fungi. As MIC breakpoints have not yet been established for onychomycosis therapies, it remains unclear if in vitro activities of antifungal drugs are predictive of clinical outcome. Well-designed clinical studies are necessary to assist clinicians in choosing the best antifungal agents.
authors.affiliation: Department of Microbiology and Parasitology, Infection and Cancer Group, University of Antioquia, Medellin, Antioquia, Colombia.
authors.forename: J G
authors.initials: JG
authors.lastname: Bueno
authors.forename: C
authors.initials: C
authors.lastname: Martinez
authors.forename: B
authors.initials: B
authors.lastname: Zapata
authors.forename: G
authors.initials: G
authors.lastname: Sanclemente
authors.forename: M
authors.initials: M
authors.lastname: Gallego
authors.forename: A C
authors.initials: AC
authors.lastname: Mesa
mesh_terms: D000704:Analysis of Variance; D000935:Antifungal Agents / Q000494:pharmacology*; D003883:Arthrodermataceae / Q000187:drug effects; D002175:Candida / Q000187:drug effects; D003105:Colombia; D004305:Dose-Response Relationship, Drug; D015725:Fluconazole / Q000494:pharmacology; D005658:Fungi / Q000187:drug effects*; D005670:Fusarium / Q000187:drug effects; D006801:Humans; D017964:Itraconazole / Q000494:pharmacology; D008826:Microbial Sensitivity Tests; D009281:Naphthalenes / Q000494:pharmacology; D014009:Onychomycosis / Q000188:drug therapy* / Q000382:microbiology; D011743:Pyrimidines / Q000494:pharmacology; D000077291:Terbinafine; D014230:Triazoles / Q000494:pharmacology; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D009281:Naphthalenes; D011743:Pyrimidines; D014230:Triazoles; D017964:Itraconazole; D015725:Fluconazole; D000077291:Terbinafine; D065819:Voriconazole