Fungal infections and antifungal drugs: has the age of antifungal resistance dawned?

摘要

Resistance against amphotericin B is rare and routinely performed in-vitro sensitivity testing is not recommended for this drug. Flucytosine resistance can be primary or secondary, has not increased over the years and can be detected reliably by routine in-vitro sensitivity testing methods such as disc diffusion. Recently, resistance is becoming a problem with the new triazoles, especially with fluconazole in the long-term treatment of oropharyngeal candidiasis in patients with AIDS. This clinical resistance correlates well with standardised in-vitro sensitivity testing according to the National Committee for Clinical and Laboratory Standards method. Another problem is the emergence of non-albicansCandidaspecies both in neutropenic and in non-neutropenic patients. Fluconazole is effective against mostCandidaspecies exceptCandida kruse'i;whereas forCandida glabratahigher doses are needed and some strains havealso to be considered resistant. Whether cross resistance against itraconazole occurs frequently is not well established, because itraconazole has not been used against candidal infections on a large scale.