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Yu SY, Zhang L, Chen S, Kong F, Xiao M, Wang H, Hou X, Zhou ML, Zhang G, Zhang JJ, Duan SM, Kang W, Xu YC. Candida isolates causing refractory or recurrent oropharyngeal candidiasis in 11 hospitals in China. Infect Drug Resist 2019; 12:865-875. [PMID: 31114266 PMCID: PMC6489570 DOI: 10.2147/idr.s199359] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 03/19/2019] [Indexed: 12/24/2022] Open
Abstract
Introduction: We studied the species distribution and antifungal susceptibilities of Candida isolates causing refractory or recurrent oropharyngeal candidiasis (OPC) in a multicenter study in China (2013–2016). Methods: Species identification was performed using the Bruker Biotyper (Bruker Daltonics, Germany) matrix-assisted laser desorption/ionization time of flight mass spectrometry system supplemented by internal transcribed spacer sequencing as required. Antifungal susceptibilities were determined by the Clinical and Laboratory Standards Institute document (CLSI) M27-A3 broth microdilution methodology. Results: A total of 558 non-duplicate Candida isolates comprising 10 species were obtained from 535 patients. Candida albicans was the most common species (89.6%), followed by C. glabrata (5.2%), C. tropicalis (2.9%), and C. parapsilosis (0.7%). Azoles were active against C. albicans with susceptibility rates of 96% and 95.8% for fluconazole and voriconazole, respectively. MIC50 values of C. albicans to fluconazole, voriconazole, itraconazole, and miconazole were 1, 0.03, 0.25 and 0.12 μg/mL, respectively, higher than those in previous studies of which OPC patients (corresponding MIC50 values of 0.25 , 0.015 , 0.06 , and 0.03 μg/mL). Except for itraconazole, the MIC50 and MIC90 values of 58 non-C. albicans to other azoles were two to threefold higher than C. albicans. Miconazole, amphotericin B, nystatin, and 5-flucytosine had good in vitro antifungal activity for all isolates. Conclusion: The study provides valuable data on the species distribution and antifungal susceptibility of oropharyngeal Candida isolates from geographically diverse areas of China. C. albicans remains the most common species but with increasing rates of azoles resistance.
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Affiliation(s)
- Shu-Ying Yu
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, People's Republic of China.,Graduate School, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, People's Republic of China.,Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases (BZ0447), Beijing, People's Republic of China
| | - Li Zhang
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, People's Republic of China.,Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases (BZ0447), Beijing, People's Republic of China
| | - Sharon Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR -New South Wales Health Pathology, The University of Sydney, Westmead, New South Wales, Australia
| | - Fanrong Kong
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR -New South Wales Health Pathology, The University of Sydney, Westmead, New South Wales, Australia
| | - Meng Xiao
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, People's Republic of China.,Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases (BZ0447), Beijing, People's Republic of China
| | - He Wang
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, People's Republic of China.,Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases (BZ0447), Beijing, People's Republic of China
| | - Xin Hou
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, People's Republic of China.,Graduate School, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, People's Republic of China.,Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases (BZ0447), Beijing, People's Republic of China
| | - Meng-Lan Zhou
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, People's Republic of China.,Graduate School, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, People's Republic of China.,Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases (BZ0447), Beijing, People's Republic of China
| | - Ge Zhang
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, People's Republic of China.,Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases (BZ0447), Beijing, People's Republic of China
| | - Jing-Jia Zhang
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, People's Republic of China.,Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases (BZ0447), Beijing, People's Republic of China
| | - Si-Meng Duan
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, People's Republic of China.,Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases (BZ0447), Beijing, People's Republic of China
| | - Wei Kang
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, People's Republic of China.,Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases (BZ0447), Beijing, People's Republic of China
| | - Ying-Chun Xu
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, People's Republic of China.,Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases (BZ0447), Beijing, People's Republic of China
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Lortholary O, Petrikkos G, Akova M, Arendrup MC, Arikan-Akdagli S, Bassetti M, Bille J, Calandra T, Castagnola E, Cornely OA, Cuenca-Estrella M, Donnelly JP, Garbino J, Groll AH, Herbrecht R, Hope WW, Jensen HE, Kullberg BJ, Lass-Flörl C, Meersseman W, Richardson MD, Roilides E, Verweij PE, Viscoli C, Ullmann AJ. ESCMID* guideline for the diagnosis and management of Candida diseases 2012: patients with HIV infection or AIDS. Clin Microbiol Infect 2013; 18 Suppl 7:68-77. [PMID: 23137138 DOI: 10.1111/1469-0691.12042] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Mucosal candidiasis is frequent in immunocompromised HIV-infected highly active antiretroviral (HAART) naive patients or those who have failed therapy. Mucosal candidiasis is a marker of progressive immune deficiency. Because of the frequently marked and prompt immune reconstitution induced by HAART, there is no recommendation for primary antifungal prophylaxis of mucosal candidiasis in the HIV setting in Europe, although it has been evidenced as effective in the pre-HAART era. Fluconazole remains the first line of therapy for both oropharyngeal candidiasis and oesophageal candidiasis and should be preferred to itraconazole oral solution (or capsules when not available) due to fewer side effects. For patients who still present with fluconazole-refractory mucosal candidiasis, oral treatment with any other azole should be preferred based on precise Candida species identification and susceptibility testing results in addition to the optimization of HAART when feasible. For vaginal candidiasis, topical therapy is preferred.
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Affiliation(s)
- O Lortholary
- Université Paris Descartes, Service des Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants malades, APHP, Centre d'Infectiologie Necker-Pasteur, IHU Imagine, Paris, France.
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3
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Puchta R, Alzoubi BM, Meier R, Almuhtaseb SI, Walther M, van Eldik R. Quantum chemical studies on the enantiomerization mechanism of several [Zn(py)3(tach)]2+ derivatives. Dalton Trans 2012; 41:14151-6. [PMID: 23034568 DOI: 10.1039/c2dt31722b] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The enantiomerization mechanism of the trigonal-prismatic [Zn(py)(3)(tach)](2+) complex and several derivatives has been studied by applying DFT calculations (B3LYP/LANL2DZp). The enantiomerization pathways of [Zn(py(3)tach-X)](2+) (X = C, Si, Ge, N, P, As, O, S and Se) start from a distorted trigonal-prismatic C(3) symmetric ground state via an ideal trigonal-prismatic C(3v) structure to end up in a C(3)' symmetric image of the ground state. The activation energy and structural data of the complexes depend on electronic and steric factors. The activation barriers of the complexes decrease in the order [Zn(py(3)tach-Ge)](2+) > [Zn(py(3)tach-Si)](2+) > [Zn(py(3)tach-As)](2+) > [Zn(py(3)tach-Se)](2+) > [Zn(py(3)tach-P)](2+) > [Zn(py(3)tach-S)](2+) > [Zn(py(3)tach-C)](2+) > [Zn(py(3)tach-N)](2+) > [Zn(py(3)tach-O)](2+).
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Affiliation(s)
- Ralph Puchta
- Inorganic Chemistry, Department of Chemistry and Pharmacy, University of Erlangen-Nürnberg, Egerlandstr. 1, 91058 Erlangen, Germany.
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4
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Uchida K, Shimogawara K, Yamaguchi H. Correlation of in vitro activity and in vivo efficacy of itraconazole intravenous and oral solubilized formulations by testing Candida strains with various itraconazole susceptibilities in a murine invasive infection. J Antimicrob Chemother 2010; 66:626-34. [PMID: 21172782 DOI: 10.1093/jac/dkq475] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To examine whether in vitro antifungal susceptibility test results correlate with in vivo efficacy of two cyclodextrin-solubilized itraconazole formulations (intravenous and oral) against Candida in a murine model of invasive infection. METHODS A selected set of 12 Candida spp. strains with various itraconazole susceptibilities were tested. We studied the efficacy of intravenous and oral itraconazole administered once daily at dosages of 0.63, 2.5, 10 and 40 mg/kg body weight in mice lethally infected with each tested strain. Survival of mice in each treated group was monitored daily until the death of all control mice and compared between groups. RESULTS Survival of mice infected with 9 of 12 Candida strains with itraconazole MICs of ≤0.016-2.0 mg/L was significantly prolonged by treatment with intravenous itraconazole at dosages of 2.5 or 10 mg/kg and above. In contrast, the other three strains resistant to 8 mg/L itraconazole in vitro were refractory to the therapy, even at the highest itraconazole dosage (40 mg/kg). Closely similar in vivo data were obtained with the oral itraconazole therapy. The effective doses of the two itraconazole formulations increased with increasing itraconazole MICs for the infecting strains. CONCLUSIONS The in vivo efficacy of intravenous and oral itraconazole correlated with the in vitro susceptibility data.
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Affiliation(s)
- Katsuhisa Uchida
- Teikyo University Institute of Medical Mycology, Hachioji, Tokyo 192-0395, Japan
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5
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Puchta R, Shaban SY, Mansour H, Alzoubi BM. Structural study of 2-pyridine-derived N(4)-p-tolyl thiosemicarbazone zinc(II) complexes–DFT analysis. J COORD CHEM 2010. [DOI: 10.1080/00958972.2010.492428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Ralph Puchta
- a Inorganic Chemistry, Department of Chemistry and Pharmacy , University of Erlangen-Nürnberg , Egerlandstr. 1, 91058 Erlangen, Germany
- b Computer Chemistry Center, Department of Chemistry and Pharmacy , University of Erlangen-Nürnberg , Nägelsbachstr. 25, 91052 Erlangen, Germany
| | - Shaban Y. Shaban
- a Inorganic Chemistry, Department of Chemistry and Pharmacy , University of Erlangen-Nürnberg , Egerlandstr. 1, 91058 Erlangen, Germany
- c Department of Chemistry, Faculty of Science , Kafrelsheikh University , Kafrelsheikh 33516, Egypt
| | - Hanaa Mansour
- a Inorganic Chemistry, Department of Chemistry and Pharmacy , University of Erlangen-Nürnberg , Egerlandstr. 1, 91058 Erlangen, Germany
- c Department of Chemistry, Faculty of Science , Kafrelsheikh University , Kafrelsheikh 33516, Egypt
| | - Basam M. Alzoubi
- a Inorganic Chemistry, Department of Chemistry and Pharmacy , University of Erlangen-Nürnberg , Egerlandstr. 1, 91058 Erlangen, Germany
- d Department of Basic Science , Zarka University College, Al-Balqa Applied University , Zarka, Jordan
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6
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Alzoubi B, Puchta R, van Eldik R. Ligand-Exchange Processes on Solvated Zinc Cations: Water Exchange on [Zn(H2O)4(L)]2+⋅2 H2O (L=Heterocyclic Ligand). Chemistry 2010; 16:7300-8. [DOI: 10.1002/chem.200902264] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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7
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Ishibashi H, Hisajima T, Hu W, Yamaguchi H, Nishiyama Y, Abe S. A murine model of esophageal candidiasis with local characteristic symptoms. Microbiol Immunol 2007; 51:501-6. [PMID: 17579259 DOI: 10.1111/j.1348-0421.2007.tb03938.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A simple method to establish a murine esophageal candidiasis model that displayed characteristic symptoms of the condition was developed using the sedative agent, chlorpromazine. Mice were immunosuppressed with prednisolone and were given tetracycline hydrochloride. One day later, the mice received chlorpromazine to keep them in a sedated state for about 3 hr. Under the sedated condition, they were infected with 4 x 10(7) viable cells of Candida albicans by intra-esophageal injection with a round-head needle on syringe. From day 3 to day 6 post inoculation, 10(5)-10(6) colony forming units of C. albicans were recovered from the esophageal tube of each mouse and whitish, curd-like patches were observed on most of the inner surface of the tube. Histological examination showed that C. albicans in esophageal lesions grew mainly in mycelial form. In this experimental model, intragastric administration of an itraconazole oral solution (20 mg/kg/day) was clearly effective. This model would provide a useful tool to investigate the pathogenesis of C. albicans esophageal infection and the efficacy of various antifungal agents microbiologically and symptomatically.
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Affiliation(s)
- Hiroko Ishibashi
- Teikyo University Research Institute of Medical Mycology, 359 Otsuka, Hachioji, Tokyo 192-0395, Japan.
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8
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Abstract
Application of pharmacodynamic principles to antifungal drug therapy of Candida and Aspergillus infections has provided and understanding of the relationship between drug dosing and treatment efficacy. Observations of the pharmacodynamics of triazoles and AmB have correlated with the results of clinical trials and have proven useful for validation of in vitro susceptibility breakpoints. Although there remain many unanswered questions regarding antifungal pharmacodynamics, available data suggest usefulness in the application of pharmacodynamics to antifungal clinical development. Future application of these principles should aid in the design of optimal combination antifungal therapies.
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Affiliation(s)
- David Andes
- Department of Medicine, Infectious Diseases Section, University of Wisconsin, Madison, WI 53792, USA.
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9
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Pfaller MA, Diekema DJ, Sheehan DJ. Interpretive breakpoints for fluconazole and Candida revisited: a blueprint for the future of antifungal susceptibility testing. Clin Microbiol Rev 2006; 19:435-47. [PMID: 16614256 PMCID: PMC1471993 DOI: 10.1128/cmr.19.2.435-447.2006] [Citation(s) in RCA: 204] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Developing interpretive breakpoints for any given organism-drug combination requires integration of the MIC distribution, pharmacokinetic and pharmacodynamic parameters, and the relationship between in vitro activity and outcome from both in vivo and clinical studies. Previously, the Subcommittee for Antifungal Testing of the Clinical and Laboratory Standards Institute (CLSI [formerly National Committee for Clinical Laboratory Standards]) proposed MIC interpretive breakpoints for fluconazole and Candida spp. These breakpoints were considered to be somewhat weak, because the clinical data supporting them came largely from mucosal infections and there were very few infections involving strains with elevated fluconazole MICs. We readdress the issue of fluconazole breakpoints for Candida by using published clinical and microbiologic data to provide further validation of the breakpoints proposed by the CLSI in 1997. We also address interpretive breakpoints for agar disk diffusion testing of fluconazole. The MIC distribution for fluconazole was determined with a collection of 13,338 clinical isolates. The overall MIC at which 90% of the isolates were inhibited was 8 microg/ml: 91% were susceptible (S) at a MIC of or= 64 microg/ml). Similar results were obtained for 2,190 isolates from randomized clinical trials. Analysis of available data for 1,295 patient-episode-isolate events (692 represented mucosal infections and 603 represented invasive infections) from 12 published clinical studies demonstrated an overall success rate of 77%, including 85% for those episodes in which the fluconazole MIC was or= 64 microg/ml) isolates. Pharmacodynamic analysis demonstrated a strong relationship between MIC, fluconazole dose, and outcome. A dose/MIC ratio of approximately 25 was supportive of the following susceptibility breakpoints for fluconazole and Candida spp.: S, MIC or= 64 microg/ml. The corresponding disk test breakpoints are as follows: S, >or=19 mm; SDD, 15 to 18 mm; R,
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Affiliation(s)
- M A Pfaller
- Department of Pathology, Medical Microbiology Division, C606 GH, University of Iowa College of Medicine, Iowa City, 52242, USA.
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Clancy CJ, Yu VL, Morris AJ, Snydman DR, Nguyen MH. Fluconazole MIC and the fluconazole dose/MIC ratio correlate with therapeutic response among patients with candidemia. Antimicrob Agents Chemother 2005; 49:3171-7. [PMID: 16048920 PMCID: PMC1196236 DOI: 10.1128/aac.49.8.3171-3177.2005] [Citation(s) in RCA: 136] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2005] [Revised: 03/24/2005] [Accepted: 04/30/2005] [Indexed: 11/20/2022] Open
Abstract
We tested 32 Candida isolates recovered in the early 1990s from the bloodstreams of patients with candidemia for in vitro susceptibility to fluconazole and determined if MIC and/or the daily dose of fluconazole/MIC ratio correlated with the response to therapy. This is a unique data set since 87.5% (28/32) of patients were treated with fluconazole doses now considered to be inadequate (=200 mg), which contributed to high therapeutic failure rates (53% [17/32]). The geometric mean MIC and dose/MIC ratio for isolates associated with therapeutic failure (11.55 mug/ml and 14.3, respectively) differed significantly from values associated with therapeutic success (0.95 mug/ml and 219.36 [P = 0.0009 and 0.0004, respectively]). The therapeutic success rates among patients infected with susceptible (MIC = 8 mug/ml), susceptible-dose dependent (S-DD) (MIC = 16 or 32 mug/ml), and resistant (MIC >/= 64 mug/ml) isolates were 67% (14/21), 20% (1/5), and 0% (0/6), respectively. A dose/MIC ratio >50 was associated with a success rate of 74% (14/19), compared to 8% (1/13) for a dose/MIC ratio =50 (P = 0.0003). Our data suggest that both fluconazole MIC and dose/MIC ratio correlate with the therapeutic response to fluconazole among patients with candidemia. In clinical practice, dose/MIC ratio might prove easier to interpret than breakpoint MICs, since it quantitates the effects of increasing fluconazole doses that are alluded to in the S-DD designation.
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Affiliation(s)
- Cornelius J Clancy
- University of Florida College of Medicine, P.O. Box 100277, JHMHC, Gainesville, FL 32610, USA.
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Abstract
PURPOSE OF REVIEW Historically the anti-infective dose and dosing interval chosen in clinical trials have been based on an arbitrary goal of maintaining drug levels in serum above the minimum inhibitory concentration of infecting pathogens for most if not all of the dosing interval. Subsequent United States Food and Drug Administration approval of a dosing regimen is then based on clinical success in treatment trials. Over the past decade, the emergence of drug resistance has limited the clinical utility of an increasing number of antimicrobial agents. However, early in drug development clinical trials do not often define the impact of infection with these less susceptible pathogens. The field of pharmacodynamics provides analysis tools that can help predict the likelihood of treatment success with various antimicrobial treatment regimens against susceptible and resistant pathogens. RECENT FINDINGS In-vitro and animal model studies have begun to define the pharmacodynamic characteristics of a variety of antifungal compounds. In-vivo studies have demonstrated that the pharmacodynamic target associated with efficacy is similar among antifungal drugs within the same class and have shown the importance of considering protein. Analysis of clinical trial data suggests that the pharmacodynamic target identified in animal model studies is predictive of outcomes in humans. SUMMARY Antifungal pharmacodynamics can be used to understand the relationship between drug dosing, in-vitro susceptibility and treatment efficacy. Consideration of these relationships can be used to optimize dosing regimens with current antifungal agents, to develop susceptibility breakpoint guidelines, and in the design of dosing regimens for drugs in early development.
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Affiliation(s)
- David Andes
- Department of Medicine, Section of Infectious Diseases, University of Wisconsin, Madison, Wisconsin 53792, USA.
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Andes D. Antifungal pharmacokinetics and pharmacodynamics: understanding the implications for antifungal drug resistance. Drug Resist Updat 2004; 7:185-94. [PMID: 15296860 DOI: 10.1016/j.drup.2004.06.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2004] [Revised: 06/04/2004] [Accepted: 06/07/2004] [Indexed: 10/26/2022]
Abstract
Pharmacodynamics (PDs) describe the relationship between drug exposure and outcome. The drug exposures in these analyses are most commonly expressed in a variety of pharmacokinetic terms. The outcome of interest with anti-infective therapy is either microbiologic resolution or a clinical surrogate of treatment efficacy. An in vitro measure of drug potency, such as the minimum inhibitory concentration (MIC) is also frequently considered in this relationship. Examination of the relationships among drug pharmacokinetics, MIC, and efficacy has provided a framework for choice of antifungal drug and dose. These analyses provide a PD target for drug class/organism combinations. The PD target can be useful for defining the upper MIC limit for a drug-dosing regimen that would be expected to result in treatment efficacy. The PD target can be used to optimize dosing regimens and to aid in defining susceptibility breakpoints.
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Affiliation(s)
- David Andes
- Department of Medicine, Section of Infectious Diseases, University of Wisconsin, 600 Highland Ave, Room H4/572, Madison, WI 53792, USA.
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14
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Abstract
Application of pharmacodynamic principles to antifungal drugs has provided an understanding of the relationship between drug dosing and treatment outcomes similar to that observed in antibacterial pharmacodynamics. Initial observations with triazole pharmacodynamics have correlated with clinical trial results and proved useful for validation of in vitro susceptibility breakpoints. Pharmacodynamic studies have been invaluable for clinical trial dosing design for numerous antibacterial drugs in the development stage. More recently, pharmacodynamics has been used for the development of treatment guidelines. Although there remain many unanswered questions regarding antifungal pharmacodynamics, available data suggest usefulness in the application of pharmacodynamics to antifungal clinical development.
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Affiliation(s)
- David Andes
- Department of Medicine, Section of Infectious Diseases, University of Wisconsin, 600 Highland Avenue, Room H4/572, Madison, WI 53792, USA.
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15
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Rex JH, Pfaller MA. Has antifungal susceptibility testing come of age? Clin Infect Dis 2002; 35:982-9. [PMID: 12355386 DOI: 10.1086/342384] [Citation(s) in RCA: 234] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2002] [Revised: 04/10/2002] [Indexed: 11/03/2022] Open
Abstract
The in vitro susceptibility of an infecting organism to the antimicrobial agent selected for therapy is one of several factors that influence the likelihood that therapy for an infection will be successful. To appreciate the value of antifungal susceptibility testing, it is helpful to review the overall predictive utility of antibacterial susceptibility testing. After >30 years of study, in vitro susceptibility can be said to predict the response of bacterial infections with an accuracy that is well summarized as the "90-60 rule": infections due to susceptible isolates respond to therapy approximately 90% of the time, whereas infections due to resistant isolates respond approximately 60% of the time. On the basis of a growing body of knowledge, standardized susceptibility testing for selected organism-drug combinations (most notably, Candida species and the azole antifungal agents) has been shown to have similar predictive utility. Antifungal susceptibility testing is now increasingly and appropriately used as a routine adjunct to the treatment of fungal infections.
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Affiliation(s)
- John H Rex
- Division of Infectious Diseases, Department of Internal Medicine, Center for the Study of Emerging and Reemerging Pathogens, University of TexasHouston Medical School, Houston 77030, USA.
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Huang H, Rodgers MT. Sigma versus Pi Interactions in Alkali Metal Ion Binding to Azoles: Threshold Collision-Induced Dissociation and ab Initio Theory Studies. J Phys Chem A 2002. [DOI: 10.1021/jp013630b] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- H. Huang
- Department of Chemistry, Wayne State University, Detroit, Michigan 48202
| | - M. T. Rodgers
- Department of Chemistry, Wayne State University, Detroit, Michigan 48202
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Sanglard D, Odds FC. Resistance of Candida species to antifungal agents: molecular mechanisms and clinical consequences. THE LANCET. INFECTIOUS DISEASES 2002; 2:73-85. [PMID: 11901654 DOI: 10.1016/s1473-3099(02)00181-0] [Citation(s) in RCA: 513] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Candida albicans and related species pathogenic for man become resistant to antifungal agents, in particular triazole compounds, by expression of efflux pumps that reduce drug accumulation, alteration of the structure or concentration of antifungal target proteins, and alteration of membrane sterol composition. The clinical consequences of antifungal resistance can be seen in treatment failures in patients and in changes in the prevalences of Candida species causing disease. These effects were seen unequivocally in HIV-infected patients with oropharyngeal candida infections, but their incidence has decreased dramatically with the introduction of highly active antiretroviral therapy. The evidence for similar emergence of antifungal-resistant yeast strains and species in other types of candida infections is confounded by non-standardised susceptibility testing methods and definitions of a resistant fungal isolate. Recent large-scale surveys of yeasts isolated from blood cultures, based on standardised methodology and resistance definitions, do not support the view that antifungal resistance in pathogenic yeasts constitutes a significant or growing therapeutic problem.
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Affiliation(s)
- Dominique Sanglard
- Institute of Microbiology, University Hospital Lausanne, Lausanne, Switzerland
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18
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Rex JH, Pfaller MA, Walsh TJ, Chaturvedi V, Espinel-Ingroff A, Ghannoum MA, Gosey LL, Odds FC, Rinaldi MG, Sheehan DJ, Warnock DW. Antifungal susceptibility testing: practical aspects and current challenges. Clin Microbiol Rev 2001; 14:643-58, table of contents. [PMID: 11585779 PMCID: PMC88997 DOI: 10.1128/cmr.14.4.643-658.2001] [Citation(s) in RCA: 278] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Development of standardized antifungal susceptibility testing methods has been the focus of intensive research for the last 15 years. Reference methods for yeasts (NCCLS M27-A) and molds (M38-P) are now available. The development of these methods provides researchers not only with standardized methods for testing but also with an understanding of the variables that affect interlaboratory reproducibility. With this knowledge, we have now moved into the phase of (i) demonstrating the clinical value (or lack thereof) of standardized methods, (ii) developing modifications to these reference methods that address specific problems, and (iii) developing reliable commercial test kits. Clinically relevant testing is now available for selected fungi and drugs: Candida spp. against fluconazole, itraconazole, flucytosine, and (perhaps) amphotericin B; Cryptococcus neoformans against (perhaps) fluconazole and amphotericin B; and Aspergillus spp. against (perhaps) itraconazole. Expanding the range of useful testing procedures is the current focus of research in this area.
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Affiliation(s)
- J H Rex
- Division of Infectious Diseases, Department of Internal Medicine, Center for the Study of Emerging and Reemerging Pathogens, University of Texas Medical School, Houston, Texas 77030, USA.
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