FUNGAL-INFECTIONS AND ANTIFUNGAL DRUGS - HAS THE AGE OF ANTIFUNGAL RESISTANCE DAWNED

Resistance against amphotericin B is rare and routinely performed in-v itro sensitivity testing is not recommended for this drug, Flucytosine resistance can be primary or secondary, has not increased over the ye ars and can be detected reliably by routine in-vitro sensitivity testi ng methods such as disc diffusion. Recently, resistance is becoming a problem with the new triazoles, especially with fluconazole in the lon g-term treatment of oropharyngeal candidiasis in patients with AIDS. T his clinical resistance correlates well with standardised in-vitro sen sitivity testing according to the National Committee for Clinical and Laboratory Standards method. Another problem is the emergence of non-a lbicans Candida species both in neutropenic and in non-neutropenic pat ients. Fluconazole is effective against most Candida species except Ca ndida krusei; whereas for Candida glabrata higher doses are needed and some strains have also to be considered resistant. Whether cross resi stance against itraconazole occurs frequently is not well established, because itraconazole has not been used against candidal infections on a large scale.