Synergistic effects of terbinafine and itraconazole on clinical isolates of Fonsecaea monophora

Eur J Dermatol. 2009 Sep-Oct;19(5):451-5. doi: 10.1684/ejd.2009.0728. Epub 2009 Jun 5.

Abstract

Our objective was to develop new approaches to the chemotherapy of invasive infections caused by Fonsecaea monophora. The in vitro effects of a combination of terbinafine with itraconazole on 18 clinical isolates were evaluated using a checkerboard microdilution method. The mode of interaction between the two drugs on the 18 isolates was analyzed using fractional inhibitory concentration index (FICI) analysis. FICI analysis demonstrated that 12 (67%) were synergistic, 4 (22%) were additive, and 2 (11%) were indifferent, with no antagonism being observed. The minimal inhibitory concentrations (MICs) obtained with the terbinafine-itraconazole combination were within levels that can be achieved in plasma at clinically relevant doses. Our results indicate the terbinafine-itraconazole combination may be an effective therapy for Fonsecaea monophora infection, which should be tested in clinical setting with patients with this disease.

MeSH terms

  • Antifungal Agents / pharmacology*
  • Ascomycota / drug effects*
  • Drug Synergism
  • Humans
  • Itraconazole / pharmacology*
  • Microbial Sensitivity Tests
  • Naphthalenes / pharmacology*
  • Terbinafine

Substances

  • Antifungal Agents
  • Naphthalenes
  • Itraconazole
  • Terbinafine