Revolving Laboratory-Stewardship for Phenotypic Resistance Profiles of Combined Antifungal Agents on Human Clinical Candida Species in a Developing Country and CoviD-19 Indications

Adenike Ogunshe; Yetunde Ekanola; Maryam Omolaja; Tiwalade Adewale

Revolving Laboratory-Stewardship for Phenotypic Resistance Profiles of Combined Antifungal Agents on Human Clinical Candida Species in a Developing Country and CoviD-19 Indications | AB Journals

Revolving Laboratory-Stewardship for Phenotypic Resistance Profiles of Combined Antifungal Agents on Human Clinical Candida Species in a Developing Country and CoviD-19 Indications

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African Journal of Biology and Medical Research

Vol. 3Issue 32020pp. 96–110Published 17 December 2020

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Abstract:

Background: Antimicrobial stewardship has always revolved round prudent antimicrobial regimens, including combined antimicrobial therapy, to curb antimicrobial resistance. But there is dearth of local microbiological data on combination antifungal therapy. Materials and Methods: 129 strains of human oral and vulvo-vaginal Candida species were assayed for phenotypic susceptibility / resistance profiles to 12 commonly-available-in-country antifungal drugs and 12 antifungal creams. Results: When tested singly, C. albicans strains were totally resistant to Primpex and Flucamed. Resistance rates of 46.6-95.2% were exhibited to remaining antifungal drugs, with multiple antibiotic resistance (MAR) of 41.7-100%. All C. glabrata strains were resistant to Fesovin; 55.7-96.2% strains exhibited resistance to other antifungals, and MAR was 41.7-100%. C. pseudotropicalis strains were totally resistant to Fesovin, Ketoconazole, Primpex and Flucamed; 36.8-84.2% strains resisted other antifungals, while MAR was 41.7-100%. C. tropicalis, exhibited resistance rates of 37.5-100% and MAR of 50.0-100%. The Candida species were resistant to all antifungal creams. Combined phenotypic assays of five most-resisted antifungal drugs and six most-resisted antifungal creams, on 40 most-resistant Candida strains gave 37.5% and 27.5% resistance (or 62.5% and 72.5% susceptibility) instead of 100% resistance (0.0% susceptibility) recorded during single antifungal drug and cream susceptibility assays. Conclusion: Appropriate laboratory-based direct-antifungal-drugs assay can serve as antimicrobial stewardship intervention, which can enhance ideal antifungal prescriptions that translates to better treatment regimens of mycotic infections, and confirm non-potent antifungals, including adulterated, fake, substandard or expired antifungals, common in some developing countries, including Nigeria.

Keywords:Combined Antifungal Therapy Commonly Available-in-Country Antimicrobials CoviD-19 Mycoses Laboratory-Derived Antifungal Prescriptions Substandard Medications.

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