Low in vitro activity of sertaconazole against clinical isolates of dermatophyte

Document Type : Original Articles

Authors

1 Department of Parasitology and Mycology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2 Allergy Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

3 Department of Community Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

4 Department of Biology, Biotechnical Faculty, University of Ljubljana, Ljubljana, Slovenia

Abstract

Background and Purpose: Dermatophytes are a group of fungi specialized in invading humans and other vertebrate keratinized tissues. These fungi cause a variety of skin, nail, and hair disorders, called dermatophytosis (tinea). In some cases, drug resistance to antifungals necessitates special treatment. Among the antifungal agents, sertaconazole (i.e., a third-generation imidazole) has a broad-spectrum against dermatophyte species. Regarding this, the present study was conducted to investigate the antifungal susceptibility of dermatophytes obtained from patients with dermatophytosis in Mashhad located in northeastern Iran.
Materials and Methods: A total of 75 clinical dermatophyte isolates, including Trichophyton mentagrophytes (n=21), T. interdigitale (n=18), T. tonsurans (n=16), Epidermophyton floccosum (n=11), Microsporum canis (n=5), Nannizzia fulvum (n=2), T. benhamiae (n=1), and T. verrucosum (n=1), were evaluated against five antifungal agents of sertaconazole, itraconazole, clotrimazole, terbinafine, and griseofulvin based on the CLSI M38-A2 guideline.
Results: According to the results, the minimum inhibitory concentration (MIC) ranges of sertaconazole, terbinafine, griseofulvin, itraconazole, and clotrimazole were estimated at 0.125-16, 0.002-1, 0.5-4, 0.031-4, and 0.016-4 μg/ml, respectively, for dermatophyte species. In addition, the geometric mean (GM) values of the MIC of sertaconazole, terbinafine, griseofulvin, itraconazole, and clotrimazole were obtained as 3.39, 1, 1.44, 1.52, and 1.93, respectively.
Conclusion: Among the tested antifungals, terbinafine and griseofulvin were the most effective agents against dermatophyte isolates. However, sertaconazole, a third-generation imidazole, did not show any significant effect. Furthermore, M. canis and E. floccosum showed the best response to the antifungal agents.
 

Keywords


1. Tanaka S, Summerbell R, Tsuboi R, Kaaman T, Sohnle P, Matsumoto T, et al. Advances in dermatophytes and dermatophytosis. J Med Vet Mycol. 1992; 30(Suppl 1):29-39.
2. de Hoog GS, Dukik K, Monod M, Packeu A, Stubbe D, Hendrickx M, et al. Toward a novel multilocus phylogenetic taxonomy for the dermatophytes. Mycopathologia. 2017; 182(1-2):5-31.
3. White TC, Oliver BG, Gräser Y, Henn MR. Generating and testing molecular hypotheses in the dermatophytes. Eukaryot Cell. 2008; 7(8):1238-45.
4. Fernández-Torres B, Carrillo AJ, Martın E, Del Palacio A, Moore MK, Valverde A, et al. In vitro activities of 10 antifungal drugs against 508 dermatophyte strains. Antimicrob Agents Chemother. 2001; 45(9):2524-8.
5. Ghannoum M. Azole resistance in dermatophytes: prevalence and mechanism of action. J Am Podiatr Med Assoc. 2016; 106(1):79-86.
6. Gupta AK, Williams JV, Zaman M, Singh J. In vitro pharmacodynamic characteristics of griseofulvin against dermatophyte isolates of Trichophyton tonsurans from tinea capitis patients. Med Mycol. 2009; 47(8):796-801.
7. Mukherjee PK, Leidich SD, Isham N, Leitner I, Ryder NS, Ghannoum MA. Clinical Trichophyton rubrum strain exhibiting primary resistance to terbinafine. Antimicrob Agents Chemother. 2003; 47(1):82-6.
8. Coelho LM, Aquino-Ferreira R, Maffei CM, Martinez-Rossi NM. In vitro antifungal drug susceptibilities of dermatophytes microconidia and arthroconidia. J Antimicrob Chemother. 2008; 62(4):758-61.
9. Pakshir K, Bahaedinie L, Rezaei Z, Sodaifi M, Zomorodian K. In vitro activity of six antifungal drugs against clinically important dermatophytes. Jundishapur J Microbiol. 2009; 2(4):158.
10. Croxtall JD, Plosker GL. Sertaconazole: a review of its use in the management of superficial mycoses in dermatology and gynaecology. Drugs. 2009; 69(3):339-59.
11. Pfaller MA, Sutton DA. Review of in vitro activity of sertaconazole nitrate in the treatment of superficial fungal infections. Diagn Microbiol Infect Dis. 2006; 56(2):147-52.
12. Carrillo-Muñoz AJ, Tur-Tur C, Giusiano G, Marcos-Arias C, Eraso E, Jauregizar N, et al. Sertaconazole: an antifungal agent for the topical treatment of superficial candidiasis. Expert Rev Anti Infect Ther. 2013; 11(4):347-58.
13. Nejati-Hoseini R, Zarrinfar H, Parian Noghani M, Parham S, Fata A, Rezaei-Matehkolaei A, et al. Identification of dermatophytosis agents in Mashhad, Iran, by using polymerase chain reaction sequencing (PCR Sequencing) method. J Isfahan Med Sch. 2019; 37:256-62.
14. Ebrahimi M, Zarrinfar H, Naseri A, Najafzadeh MJ, Fata A, Parian M, et al. Epidemiology of dermatophytosis in northeastern Iran; A subtropical region. Curr Med Mycol. 2019; 5(2):16-21.
15. Rand S. Overview: the treatment of dermatophytosis. J Am Acad Dermatol. 2000; 43(5):S104-12.
16. Gupta AK, Hofstader SL, Adam P, Summerbell RC. Tinea capitis: an overview with emphasis on management. Pediatr Dermatol. 1999; 16(3):171-89.
17. Baghi N, Shokohi T, Badali H, Makimura K, Rezaei-Matehkolaei A, Abdollahi M, et al. In vitro activity of new azoles luliconazole and lanoconazole compared with ten other antifungal drugs against clinical dermatophyte isolates. Med Mycol. 2016; 54(7):757-63.
18. Abastabar M, Jedi A, Guillot J, Ilkit M, Eidi S, Hedayati MT, et al. In vitro activities of 15 antifungal drugs against a large collection of clinical isolates of Microsporum canis. Mycoses. 2019; 62(11):1069-78.
19. Yenişehirli G, Tunçoğlu E, Yenişehirli A, Bulut Y. In vitro activities of antifungal drugs against dermatophytes isolated in Tokat, Turkey. Int J Dermatol. 2013; 52(12):1557-60.
20. Chadeganipour M, Nilipour S, Havaei A. In vitro evaluation of griseofulvin against clinical isolates of dermatophytes from Isfahan. Mycoses. 2004; 47(11‐12):503-7.
21. Fernández-Torres B, Cabanes FJ, Carrillo-Munoz AJ, Esteban A, Inza I, Abarca L, et al. Collaborative evaluation of optimal antifungal susceptibility testing conditions for dermatophytes. J Clin Microbiol. 2002; 40(11):3999-4003.
22. Silva LB, de Oliveira DB, da Silva BV, de Souza RA, da Silva PR, Ferreira‐Paim K, et al. Identification and antifungal susceptibility of fungi isolated from dermatomycoses. J Eur Acad Dermatol Venereol. 2014; 28(5):633-40.
23. Wiederhold NP, Fothergill AW, McCarthy DI, Tavakkol A. Luliconazole demonstrates potent in vitro activity against dermatophytes recovered from patients with onychomycosis. Antimicrob Agents Chemother. 2014; 58(6):3553-5.
24. Ghannoum M, Wraith L, Cai B, Nyirady J, Isham N. Susceptibility of dermatophyte isolates obtained from a large worldwide terbinafine tinea capitis clinical trial. Br J Dermatol. 2008; 159(3):711-3.
25. Ansari S, Hedayati MT, Zomorodian K, Pakshir K, Badali H, Rafiei A, et al. Molecular characterization and in vitro antifungal susceptibility of 316 clinical isolates of dermatophytes in Iran. Mycopathologia. 2016; 181(1-2):89-95.
26. Badali H, Mohammadi R, Mashedi O, de Hoog GS, Meis JF. In vitro susceptibility patterns of clinically important Trichophyton and Epidermophyton species against nine antifungal drugs. Mycoses. 2015; 58(5):303-7.
27. Afshari MA, Shams-Ghahfarokhi M, Razzaghi-Abyaneh M. Antifungal susceptibility and virulence factors of clinically isolated dermatophytes in Tehran, Iran. Iran J Microbiol. 2016; 8(1):36-46.
28. Adimi P, Hashemi SJ, Mahmoudi M, Mirhendi H, Shidfar MR, Emmami M, et al. In-vitro activity of 10 antifungal agents against 320 dermatophyte strains using microdilution method in Tehran. Iran J Pharm Res. 2013; 12(3):537-45.
29. Arastehfar A, Khodavaisy S, Daneshnia F, Najafzadeh MJ, Mahmoudi S, Charsizadeh A, et al. Molecular identification, genotypic diversity, antifungal susceptibility, and clinical outcomes of infections caused by clinically underrated yeasts, Candida orthopsilosis and Candida metapsilosis: An Iranian multicenter study (2014-2019). Front Cell Infect Microbiol. 2019; 9:264.
30. Martinez-Rossi NM, Peres NT, Rossi A. Antifungal resistance mechanisms in dermatophytes. Mycopathologia. 2008; 166(5-6):369-83.
31. Falahati M, Fateh R, Nasiri A, Zaini F, Fattahi A, Farahyar S. Specific identification and antifungal susceptibility pattern of clinically important dermatophyte species isolated from patients with dermatophytosis in Tehran, Iran. Arch Clin Infect Dis. 2018; 13(3):e63104.
32. Ghannoum M, Isham N, Sheehan D. Voriconazole susceptibilities of dermatophyte isolates obtained from a worldwide tinea capitis clinical trial. J Clin Microbiol. 2006; 44(7):2579-80.
33. Carrillo-Muñoz A, Fernández-Torres B, Cárdenes D, Guarro J. In vitro activity of sertaconazole against dermatophyte isolates with reduced fluconazole susceptibility. Chemotherapy. 2003; 49(5):248-51.
34. Shivamurthy RP, Reddy SG, Kallappa R, Somashekar SA, Patil D, Patil UN. Comparison of topical anti-fungal agents sertaconazole and clotrimazole in the treatment of tinea corporis-an observational study. J Clin Diagn Res. 2014; 8(9):HC09-12.
35. Fernández-Torres B, Inza I, Guarro J. In vitro activities of the new antifungal drug eberconazole and three other topical agents against 200 strains of dermatophytes. J Clin Microbiol. 2003; 41(11):5209-11.