Combining Fluconazole with Non-antifungal agents May Offer New Avenue for Treating Fungal Infections

With the recent emergence of fluconazole-resistant Candida albicans isolates, the combination of fluconazole with different classes of non-antifungal agents—such as antibacterial, calcineurin inhibitors, heat shock protein 90 inhibitors, calcium homeostasis regulators, and traditional Chinese medicine—may represent a promising therapeutic approach, new research finds. Researchers have found that many of these combinations showed synergistic effects against C. albicans, especially resistant strains. The main mechanisms of these effects appear to be increasing the permeability of the membrane, thus reducing the efflux of antifungaldrugs, interfering with intracellular ion homeostasis, inhibiting the activity of proteins and enzymes required for fungal survival, and inhibiting biofilm formation.

These modes of action and the antifungal mechanisms of various compounds, according to the researchers, highlight the idea that the reversal of fungal resistance can be achieved through various mechanisms. The authors note that future research examining drug interactions will hopefully provide new approaches against antifungal drug resistance as well as insight into antifungal agent discovery.

—Int J Antimicrob Agents. Jan 22, 2014

Q-Switched Nd:YAG 1064 nm/532 nm Laser Found Effective for Onychomycosis

A new study has found that fungal nail infections can be effectively and safely treated with Q-Switched Nd:YAG 1064nm/532nm laser. For the study, investigators used the Q-Switched Nd:YAG 1064nm/532nm laser on 131 onychomycosis patients for two sessions with a one-month interval. Applying laser fluencies of 14 J/cm2 at 9 billionths of a second pulse duration and at 5 Hz frequency, researchers then observed patients over a three-month time period, after which they took mycological cultures. All patients were well satisfied with the treatments and there were no noticeable side effects. At the three-month follow-up, 95.42 percent of the patients were laboratory mycologically cured of fungal infection. Finally, the researchers noted that Nd:YAG 1064nm/532nm laser can be combined with systemic oral antifungals providing more limited treatment time.

—Dermatol Res Pract. Dec 14, 2013

Terbinafine Film-Forming Solution Yields Positive Results for Treatment of Tinea Pedis

One single topical application of 1% terbinafine film-forming solution (FFS) was recently found both safe and effective in the treatment of tinea pedis in the Chinese population. Researchers randomized 290 patients in China to receive either 1% terbinafine FFS or FFS vehicle (placebo) once on the affected foot/feet. Efficacy assessments included microscopy and mycologic culture, and assessing clinical signs and symptoms at baseline, and at weeks one and six after the topical treatment. After six weeks, 1% terbinafine FFS was superior to placebo for effective treatment rate (63 percent vs. eight percent); clinical cure (30 percent vs. six percent); mycological cure (86 percent vs. 12 percent); negative microscopy (90 percent vs. 24 percent); and negative mycological culture (90 percent vs. 27 percent). Moreover, 1% terbinafine FFS was clinically superior to placebo for the absence of: erythema, desquamation, and pruritus. Differences in the average total signs and symptoms scores were significantly lower for 1% terbinafine FFS versus placebo. Additionally, both 1% terbinafine safe and placebo well tolerated based on adverse events and investigator and patient assessments.

— Clin Drug Investig. Jan 30, 2014

Topical Naftifine Beneficial for Cutaneous Dermatophytosis and Other Fungal Infections

In a new report co-authored by Practical Dermatology® editorial board member Leon H. Kircik, MD, naftifine has been credited with not only expanding the treatment armamentarium for the treatment of fungal infections but it also offers a clinically relevant therapeutic reservoir effect after completion of therapy. The report notes that naftifine is fungicidal in vitro against a wide spectrum of dermatophyte fungi and has been shown to be highly effective against a variety of cutaneous dermatophyte infections, with a documented rapid onset of clinical activity and favorable data on sustained clearance of infection.

—J Drugs Dermatol. Nov 1, 2013; 12(11): s165-71.