- Email: [email protected]
In vitro Activity of Six Antifungal Agents on Clinical Dermatophytes
e284
13th International Congress on Infectious Diseases Abstracts, Poster Presentations
45.020
45.021
In vitro Activity of Six Antifungal Agents on Clinical Dermatophytes
Premedication Practices and Incidence of Infusion-related Reactions in Patients Receiving AMPHOTEC: Data from the PRoACT-Patient Registry of Amphotericin B Cholesteryl Sulfate Complex for Injection Clinical Tolerability
K. Pakshir 1,∗ , L. Bahaedinie 2 , Z. Rezaei 2 , M. Sodaifi 3 , K. Zomorodian 1 1
Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran (Islamic Republic of) 2 Faculty of Pharmacy and Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran (Islamic Republic of) 3 Department of Dermatology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran (Islamic Republic of) Background: Dermatophytosis is a common fungal disease which affected derma and their appendages. Many antifungal drugs prescribe ordinary against dermatophytosis every day and there are many reports concerning on failure in treatment of dermatophytosis. Antifungal susceptibility testing is a very dynamic field of medical mycology. In this study, antifungal activities of six antifungal agents were evaluated against clinically isolated of dermatophytes in Shiraz, Southern Iran. Method: Forty clinical dermatophytes were isolated and identified from patients suspected of dermatophytosis referred to the mycology laboratory of Shiraz Medical School. Home made antifungal disks were prepared from standard powders of terbinafine, griseofulvin, clotrimazole, miconazole, fluconazole and Ketoconazole. Antifungal susceptibility test performed by disk diffusion method and the mean diameter of the inhibition zones around the disks were measured and compared with the disk controls. Results: The isolates belong to three genera and eight species as Trichophyton mentagrophytes (13) Trichophyton rubrum(8), Epidermophyton floccosum (7), Trichophyton violaceum (4), Microsporum gypseum (3), Trichophyton tonsurance (2), Trichophyton verrucosum (2), Trichophyton schoenlineii (1) and unknown dermatophyte (1). There was no resistance isolates to clotrimazole and miconazole and the other antifungal drugs reveals different ranges of resistance on dermatophyte isolates. Fluconazole had poor effects on the isolates. Conclusion: This study reveals that clotrimazole, terbinafine, miconazole and griseofulvin were the best antifungal agents in treatment of dermatophytosis. Disk diffusion method is a simple and valuable method for dermatophyte susceptibility testing and could be uses for evaluation of dermatophyte resistance in routine medical laboratories.
G. Krivàn 1 , M. Mrsic 2 , K. David 3 , D. Paterson 4,∗ 1
St. Laszlo Hosp., BMT Unit, Budapest, Hungary University Hospital Center, Zagreb, Croatia 3 ProSanos Corp., Harrisburg, PA, USA 4 University of Pittsburgh, Pittsburg, PA, USA 2
Background: Clinical trials have suggested infusionrelated reactions (IRR) may occur at a higher rate with Amphotericin B Cholesteryl Sulfate Complex for Injection (AMPHOTEC) vs. other forms of amphotericin B. However, these trials did not permit the use of pre-medications upfront, which are now commonly used. This observational study was undertaken to describe use of pre-medications and determine the rate of IRR in the real-world setting. Methods: The Patient Registry of AMPHOTEC Clinical Tolerability (PRoACT) is a multi-center, worldwide observational registry capturing real-world data about current pre-medication practices and incidence of IRR in patients receiving AMPHOTEC therapy. Patients beginning treatment with AMPHOTEC were eligible for enrollment, and were treated according to their site’s standard treatment practice. Incidence of IRR was collected during the first 10 days of AMPHOTEC therapy. Additional labs (serum creatinine, liver function tests) were collected up to 12 wks after treatment start and at drug discontinuation. Results: From November 1, 2006 to December 31, 2007, 180 hospitalized adult and pediatric patients from 20 world-wide sites were enrolled in PRoACT. Evaluable data on 170 patients from 18 sites are available and reported here (median age 37 yrs [range 0—72]; 51.8% male; 21.8% Asian; 78.2% white). There were a total of 1230 AMPHOTEC infusions (mean/median [range] dose 167 mg/150 mg [15—580 mg]). Most infusions (90%; 1105/1230) had pre-medications. Common premedications included: dexamethasone, methylprednisone, acetaminophen. The IRR rate was 12% (147/1230). The most common IRR were chills (n = 85), fever (n = 86) and rigors (n = 65); most (86%) were low severity (Common Toxicity Criteria stage 1 or 2). Other IRR occurred in < 1.1% of injections. Pre-treatment was associated with decreased odds for IRR (OR: 0.41, p < .002 [Chi square]). Conclusions: These data suggest a low rate of IRR with AMPHOTEC; pre-treatment is associated with decreased IRR incidence. doi:10.1016/j.ijid.2008.05.763
doi:10.1016/j.ijid.2008.05.762
13th International Congress on Infectious Diseases Abstracts, Poster Presentations
45.020
45.021
In vitro Activity of Six Antifungal Agents on Clinical Dermatophytes
Premedication Practices and Incidence of Infusion-related Reactions in Patients Receiving AMPHOTEC: Data from the PRoACT-Patient Registry of Amphotericin B Cholesteryl Sulfate Complex for Injection Clinical Tolerability
K. Pakshir 1,∗ , L. Bahaedinie 2 , Z. Rezaei 2 , M. Sodaifi 3 , K. Zomorodian 1 1
Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran (Islamic Republic of) 2 Faculty of Pharmacy and Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran (Islamic Republic of) 3 Department of Dermatology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran (Islamic Republic of) Background: Dermatophytosis is a common fungal disease which affected derma and their appendages. Many antifungal drugs prescribe ordinary against dermatophytosis every day and there are many reports concerning on failure in treatment of dermatophytosis. Antifungal susceptibility testing is a very dynamic field of medical mycology. In this study, antifungal activities of six antifungal agents were evaluated against clinically isolated of dermatophytes in Shiraz, Southern Iran. Method: Forty clinical dermatophytes were isolated and identified from patients suspected of dermatophytosis referred to the mycology laboratory of Shiraz Medical School. Home made antifungal disks were prepared from standard powders of terbinafine, griseofulvin, clotrimazole, miconazole, fluconazole and Ketoconazole. Antifungal susceptibility test performed by disk diffusion method and the mean diameter of the inhibition zones around the disks were measured and compared with the disk controls. Results: The isolates belong to three genera and eight species as Trichophyton mentagrophytes (13) Trichophyton rubrum(8), Epidermophyton floccosum (7), Trichophyton violaceum (4), Microsporum gypseum (3), Trichophyton tonsurance (2), Trichophyton verrucosum (2), Trichophyton schoenlineii (1) and unknown dermatophyte (1). There was no resistance isolates to clotrimazole and miconazole and the other antifungal drugs reveals different ranges of resistance on dermatophyte isolates. Fluconazole had poor effects on the isolates. Conclusion: This study reveals that clotrimazole, terbinafine, miconazole and griseofulvin were the best antifungal agents in treatment of dermatophytosis. Disk diffusion method is a simple and valuable method for dermatophyte susceptibility testing and could be uses for evaluation of dermatophyte resistance in routine medical laboratories.
G. Krivàn 1 , M. Mrsic 2 , K. David 3 , D. Paterson 4,∗ 1
St. Laszlo Hosp., BMT Unit, Budapest, Hungary University Hospital Center, Zagreb, Croatia 3 ProSanos Corp., Harrisburg, PA, USA 4 University of Pittsburgh, Pittsburg, PA, USA 2
Background: Clinical trials have suggested infusionrelated reactions (IRR) may occur at a higher rate with Amphotericin B Cholesteryl Sulfate Complex for Injection (AMPHOTEC) vs. other forms of amphotericin B. However, these trials did not permit the use of pre-medications upfront, which are now commonly used. This observational study was undertaken to describe use of pre-medications and determine the rate of IRR in the real-world setting. Methods: The Patient Registry of AMPHOTEC Clinical Tolerability (PRoACT) is a multi-center, worldwide observational registry capturing real-world data about current pre-medication practices and incidence of IRR in patients receiving AMPHOTEC therapy. Patients beginning treatment with AMPHOTEC were eligible for enrollment, and were treated according to their site’s standard treatment practice. Incidence of IRR was collected during the first 10 days of AMPHOTEC therapy. Additional labs (serum creatinine, liver function tests) were collected up to 12 wks after treatment start and at drug discontinuation. Results: From November 1, 2006 to December 31, 2007, 180 hospitalized adult and pediatric patients from 20 world-wide sites were enrolled in PRoACT. Evaluable data on 170 patients from 18 sites are available and reported here (median age 37 yrs [range 0—72]; 51.8% male; 21.8% Asian; 78.2% white). There were a total of 1230 AMPHOTEC infusions (mean/median [range] dose 167 mg/150 mg [15—580 mg]). Most infusions (90%; 1105/1230) had pre-medications. Common premedications included: dexamethasone, methylprednisone, acetaminophen. The IRR rate was 12% (147/1230). The most common IRR were chills (n = 85), fever (n = 86) and rigors (n = 65); most (86%) were low severity (Common Toxicity Criteria stage 1 or 2). Other IRR occurred in < 1.1% of injections. Pre-treatment was associated with decreased odds for IRR (OR: 0.41, p < .002 [Chi square]). Conclusions: These data suggest a low rate of IRR with AMPHOTEC; pre-treatment is associated with decreased IRR incidence. doi:10.1016/j.ijid.2008.05.763
doi:10.1016/j.ijid.2008.05.762